CMS News
FOR IMMEDIATE RELEASE
August 1, 2016
August 1, 2016
Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
(202) 690-6145 | CMS Media Inquiries
CMS announces next phase in largest-ever
initiative to improve primary care in America
Today, the Centers for Medicare
& Medicaid Services (CMS) opened the application period for practices to
participate in the new nation-wide primary care model, Comprehensive Primary
Care Plus (CPC+). CPC+ is a five-year primary care medical home model beginning
January 2017 that will enable primary care practices to care for their patients
the way they think will deliver the best outcomes and to pay them for achieving
results and improving care. CPC+ is an opportunity for practices of diverse
sizes, structures, and ownership who are interested in qualifying for the
incentive payment for Advanced Alternative Payment Models through the proposed
Quality Payment Program. CMS estimates that up to 5,000 primary care practices
serving an estimated 3.5 million beneficiaries could participate in the model.
CPC+ is a public-private
partnership in 14 regions across the nation. CPC+ is a multi-payer model -
Medicare, state Medicaid agencies, and private insurance companies partner
together to support primary care practices - so CMS selected the regions based
on payer interest and coverage. By aligning Medicare, Medicaid, and private
insurance, CPC+ moves the health care system away from one-size-fits-all,
fee-for-service to a model that supports clinicians delivering the care that
best meets the needs of their patients and improves health outcomes.
The following regions were selected
for CPC+. Eligible practices in these 14 regions may apply between August 1 and
September 15, 2016 to participate in CPC+:
- Arkansas: Statewide
- Colorado: Statewide
- Hawaii: Statewide
- Kansas and Missouri: Greater Kansas City Region
- Michigan: Statewide
- Montana: Statewide
- New Jersey: Statewide
- New York: North Hudson-Capital Region
- Ohio: Statewide and Northern Kentucky Region
- Oklahoma: Statewide
- Oregon: Statewide
- Pennsylvania: Greater Philadelphia Region
- Rhode Island: Statewide
- Tennessee: Statewide
“As a key part of CPC+, CMS and
partner payers are committed to supporting primary care practices of all sizes,
including small, independent, and rural practices,” said Dr. Patrick Conway,
CMS deputy administrator and chief medical officer. “We see CPC+ as the future
of primary care in the U.S. and are pleased to partner with payers across the
country that are aligned in this mission to transform our health care system.
This model allows primary care practices to focus on what they care about most
– serving their patients’ needs when and how they choose.”
Building on the Comprehensive Primary Care initiative that
launched in late 2012, CPC+ will benefit patients by helping primary care
practices:
- Support
patients with serious or chronic diseases achieve their health goals
- Give
patients 24-hour access to care and health information
- Deliver
preventive care
- Engage
patients and their families in their own care
- Work
together with hospitals and other clinicians, including specialists, to
provide better-coordinated care
Practices may participate in one of
two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition
to regular Medicare fee-for-service payments. In Track 2, practices will
receive the monthly fee, as well as a hybrid of reduced Medicare
fee-for-service payments and up-front comprehensive primary care payments to
allow greater flexibility in how practices deliver care. Practices in Track 2
will provide more comprehensive services for patients with complex medical and
behavioral health needs, including, as appropriate, a systematic assessment of
their psychosocial needs and an inventory of resources and supports to meet
those needs. To promote high quality and high value care, practices in both
tracks will also receive prospective performance-based incentive payments that
they will either keep or have to pay back to CMS based on their performance on
quality and utilization metrics. In addition, practices that participate in
CPC+ may qualify for the additional incentive payments available for the
Advanced Alternative Payment Models in the proposed Quality Payment Program
beginning 2019.
The Affordable Care Act, through
the creation of the Center for Medicare and Medicaid Innovation, allows for the
testing of innovative payment and service delivery models, such as the CPC+
model, to move our health care system toward one that rewards clinicians based
on the quality, not quantity of care they provide patients. Today’s
announcement is part of the Administration’s broader strategy to improve the
health care system by paying providers for what works, unlocking health care
data, and finding new ways to coordinate and integrate care to improve quality.
This new model supports the Administration’s goal to have 50 percent of
traditional Medicare payments flowing through alternative payment models by
2018 (already, 30 percent of Medicare payments go through alternative models).
For questions about the model or
the application process, visit http://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus
or email CPCplus@cms.hhs.gov
