New Primary Care Payment Model Promotes Care Coordination

Added on May 19, 2016

New Primary Care Payment Model Promotes Care Coordination
From Industry Edge May 2016

A large-scale test program of an advanced primary care medical home model, called Comprehensive Primary Care Plus (CPC+), will shift Medicare payment to physician practices toward a more coordinated approach.

The “largest-ever initiative to transform and improve how primary care is delivered and paid for in America,” CPC+ is slated for launch in January 2017, according to the Centers for Medicare & Medicaid Services (CMS). The five-year test could encompass more than 20,000 doctors and medical providers and more than 25 million consumers in January. The program would be implemented in as many as 20 regions and may enroll as many as 5,000 practices.

“By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists, we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars,” CMS Chief Medical Officer, Dr. Patrick Conway, said in a statement.

CMS is working to move much of Medicare’s more than $600 billion in annual payments away from the traditional fee-for service approach to care, which is seen as a root cause of poor coordination of care. The agency wants to tie more physician payments (about half by 2018) to measures of how well patients’ care is coordinated or their health is preserved or regained. Among the major Medicare tests under way is a model that will tie payment for many hip and knee replacements to judgments about how well patients fare in the 90 days after surgery.

Under the new model, Medicare will partner with commercial and state health insurance plans to support physician practices in delivering advanced primary care, which is care that includes five key components.

  • Services are accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in person hours and 24/7 telephone or electronic access.
  • Patients at highest risk receive proactive, relationship-based care management services to improve outcomes.
  • Care is comprehensive, and practices can meet the majority of each individual’s physical and mental health care needs, including prevention. Care is also coordinated across the health care system, including specialty care and community services, and patients receive timely follow-up after emergency room or hospital visits.
  • It is patient-centered, recognizing that patients and family members are core members of the care team, and actively engages patients to design care that best meets their needs.
  • Quality and utilization of services are measured, and data is analyzed to identify opportunities for improvements in care and to develop new capabilities.

The primary care program consists of two tracks. For practices participating in Track 1, CMS would pay a monthly care management fee in addition to the usual fee-for-service payments for doctors’ care. Practices participating in Track 2 also would get a monthly care management fee while shifting to a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. The intent is to allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter, CMS said.

Primary care practices in both tracks will get feedback through data on their costs and use of health services. Those enrolled in Track 2 will sign an agreement with CMS to commit to supporting enhanced health information technology capabilities.