The Comprehensive Primary Care Plus (CPC+) model announced April 11 by CMS will work with private insurers to pay participating primary care providers a per beneficiary per month (PBPM) fee, allowing them to design their own care choices for patients, including services not currently paid under the Medicare fee-for-service model.
Thus, payments would be “not based on volume but on health outcomes,” said Patrick Conway, M.D., CMS principal deputy administrator and chief medical officer at the announcement.
This new advanced primary care medical home model is based on the original Comprehensive Primary Care Initiative, launched by the CMS Innovation Center in October 2012. That program also brought together primary care practices and insurers and provided a care management fee to providers as well shared savings payments in high-performing regions.
The new program has two tracks, each with varying “tiers” of risk based on challenges in their patient populations; each track will have four basic tiers, and track 2 will have a fifth “complex” tier. The average PBPM will be $15 in track 1 and $28 in track 2, but the payments will vary from $6 in the first tier of the first track to $100 for complex tier patients.
Providers also will receive fee-for-service payments, but track 2 participants will receive what CMS describes in an FAQ as “a hybrid of Medicare fee-for-service payments and the ‘Comprehensive Primary Care Payment’ (CPCP),” in which they will be paid upfront for anticipated E/M services to patients. CMS says it will “recoup payments made to practices if they do not meet quality and utilization and performance thresholds.”
Track 2 affords providers "even more freedom to design care,” says Conway. “If telehealth makes sense, they can do that; ... if longer visits make sense, they can do that, too.” Telehealth is rarely paid under fee-for-service Medicare.
Under its "staged application process," practice are expected to apply for participation in the Comprehensive Primary Care Plus (CPC+) model between July 15 and Sept. 1. The request for application is here.