“Rome was not built in one day, but they were laying bricks every hour.” – John Heywood
U.S. healthcare is in a period of revolution, both in terms of payment and care delivery. In every corner of the country, initiative after initiative are being launched with the goals of reducing total healthcare expenditures, improving quality and improving the health of populations. Comprehensive Primary Care Plus, scheduled to launch next year, is just one of the latest of these initiatives.
What makes CPC+ stand out from the pack is a recent decision from the Centers for Medicare & Medicaid Services that allows physicians who participate in the Medicare Shared Savings Program to also participate in CPC+. By doing so, CMS tackled the threat of physicians fleeing the MSSP in order to join CPC+, which offers advance payments and more incentives from payers.
Additionally, CMS proves with the decision that it is actually listening to providers who have been pleading with the government to better coordinate its plethora of programs, as CMS has decided to avoid markets for the CPC+ initiative that overlap with sites already participating in the very similar Multi-Payer Advanced Primary Care Practice demonstration (MAPCP).
As the name implies, CPC+ adds to its predecessor program, the Comprehensive Primary Care initiative, which launched in 2011. The original CPC was a four-year, multi-payer initiative aimed at shifting Medicare payments from volume to value. It covered seven regions and included 500 physician practices. The single-payment model paid participating providers $20 per beneficiary per month for the first two years of the program. For the last two years, payments were reduced to $15 per beneficiary per month.
An evaluation of the program by policy research group Mathematica found the CPC initiative was able to reduce total monthly Medicare expenditure without care management fees during its first program year by $14 per beneficiary. This was sufficient to cover the CPC initiative’s monthly care management fees, which averaged $20 per patient per month among participating practices. The Mathematica study also reported an overall decline in hospitalizations, emergency department visits, specialist visits and primary care visits among patients accessing care under the program.
Despite these successes, the CPC initiative was still fundamentally a volume-based model, since physicians were paid a traditional FFS reimbursement with a care management fee on top. Enter CPC+, which offers two payment tracks, both of which are value-based. Under Track 1, practices will receive monthly care management fees in addition to FFS payments. Average fees are $15 per beneficiary per month and $2.50 per beneficiary per month if practices perform well. Under Track 2, practices will receive monthly care management fees, as well as a combination of reduced Medicare FFS payments and up-front Comprehensive Primary Care payments for services rendered. Risk adjusted payments under this track range from $27 to $100 per beneficiary per month for high-risk patients, plus an additional $4 per beneficiary per month based on performance.
According to American College of Physicians, CPC+ will be rolled out in up to 20 regions and can accommodate more than 20,000 doctors and clinicians– a 10-fold increase in the number of participating practices from the original initiative.
The original CPC initiative was in CMS achieving its goal of shifting 30 percent of Medicare payments to alternative models by 2016—a goal CMS hit nearly a year early. Now, CMS has set its sights on raising that share to half of all Medicare payments to alternative payment models by 2018, and the spotlight will be on CPC+.