The Centers for Medicare & Medicaid Services (CMS) has announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in the US.
The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve.
The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.
Dr Patrick Conway, deputy administrator and chief medical officer, CMS, said: “Strengthening primary care is critical to an effective health care system. 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.
“The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”
Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model will benefit patients by helping primary care practice support patients with serious or chronic diseases to achieve their health goals and give patients 24-hour access to care and health information. It will also deliver preventive care, engage patients and their families in their own care, and work together with hospitals and other clinicians, including specialists, to provide better coordinated care.
Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also 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.
Under the CPC+ model, Medicare will partner with commercial and state health insurance plans to support primary care practices in delivering advanced primary care.
CMS will select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative. CMS will enter into a Memorandum of Understanding (MOU) with selected payer partners to document a shared commitment to align on payment, data sharing, and quality metrics in CPC+.
CMS will accept payer proposals to partner in CPC+ from April 15 through June 1, 2016. The firm will accept practice applications in the determined regions from July 15 through September 1, 2016.
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 the health care system toward one that rewards clinicians based on the quality, not quantity, of care they give patients.
Centers for Medicare & Medicaid Services, CMS, Healthcare, Primary care, Comprehensive Primary Care Plus model, Dr Patrick Conway, US