Comprehensive Primary Care Plus Unveiled

Published May 6, 2016

On April 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the launch of a new advanced primary care medical home model called Comprehensive Primary Care Plus (CPC+) which rewards value and quality by offering a new payment scheme for physicians that encourage delivery of care outside the physician’s office. CPC+ is a five-year model scheduled to begin on January 1, 2017. CMS states that CPC+ will support up to 5,000 practices in up to 20 regions, which would encompass 20,000 physicians and the 25 million people they serve. CPC+ is designed to encourage physicians and practices to deliver high-quality services, and to manage patients with complex chronic conditions, while keeping costs under control. The new plan presents an opportunity for previously unparalleled engagement of home-based care services.

CMS Chief Medical Officer Dr. Patrick Conway touted the program as a way to strengthen primary care, serve patients outside the traditional office visit, coordinate with specialists, and save costs.

The Two Track System

CPC+ will be rolled out in two tracks. Both tracks reimburse providers on a per-patient-per-month basis, along the lines of traditional managed care models. Track One provides a small incentive payment for coordination of care. Track Two provides a greater incentive payment but smaller reimbursement for office visits. This track encourages physicians to develop creative ways to manage patients’ problems outside the traditional office visit model. Depending on how well each practice performs on various outcome metrics, they will keep their incentive payments, or return them to CMS, as the case may be. Track Two provides the greater potential reimbursement, but requires greater creativity on the part of the practice. The initiative signals a commitment on the part of CMS to shift the focus from “quantity to quality” of care provided.

There are a number of ways a physician or practice can deliver care outside of an office: Use of email, telemedicine, community-based services and other health information technologies. But the greatest opportunity lies in the potential use of home-based resources.

The Window of Opportunity for Home Health

For physicians and practices who adopt Track Two, there will be a greater incentive to employ home-based services to care for patients with complex and chronic illnesses. One such chronic illness is congestive heart failure (CHF). CHF is the leading cause of expensive hospital readmissions. Under CPC+, practices could use their incentive payments to pay for a home health provider to visit CHF patients to weigh them and ensure that they are adhering to their prescribed medication plans.

We have known for a long time that the physician’s office is not the only place to deliver quality healthcare. For elderly and disabled patients, it’s clearly preferable to have care come to them, rather than having to be driven to an appointment. With the roll-out of CPC+, physicians now have the incentive to offer this kind of high-quality, highly sought-after care, to the patients that need care most.