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June 21, 2016

An Overview of the CMS CPC+ Model

June 21, 2016

cpc+ model

Earlier this year, the Center for Medicare and Medicaid Service (CMS) announced its latest payment program: the Comprehensive Primary Care Plus (CPC+) model.

Set to start at the beginning of 2017, CPC+ is a payment model that will give a monthly payment to providers to manage care for patients, in an effort to create more flexibility in how providers deliver a higher standard of care to their patients.

The goal is to help practices constantly improve the quality of care without just focusing on cutting costs.

Initially, the CPC+ model will be rolled out to over 20,000 providers spread across 5,000 practices in 20 regions that care for over 25 million patients. The regions to take part in the plan will be announced in July, and these will depend on interest from payers in those regions who may want to participate.

CPC+ will be broken up into two tracks:

  • Track 1: Providers will receive a monthly fee for specific services (plus all the fee-for-service payments that Medicare currently pays). At the beginning, the monthly payment will be $15 per beneficiary.
  • Track 2: Providers will also receive a monthly payment, but in lieu of the full fee-for-service Medicare payments, they will receive reduced fee-for-service payments on top of a comprehensive primary care payment paid up front. That results in a payment of $28 per beneficiary per month, on average, at the beginning of the plan.

Additionally, there is an incentive program that will make additional payments if the providers meet a few requirements. These requirements range from providing more proactive care to high-risk patients to measuring and analyzing data for the quality of service delivered and better engaging patients and families.

There’s still some uncertainty about how CPC+ will fall into CMS’ other initiatives. The model could count as an alternative payment model (APM), which would exempt providers from participating in CMS’ Merit-based Incentive Payments System (MIPS). This would not begin until 2019, and at any rate, there’s still no firm guidance from CMS on APM.

One thing is clear: under the CPC+ model, providers will have more of an incentive to improve the quality of patient care while having to avoid just focusing on cutting costs, which has preoccupied many providers for years.

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