AAFP president: CPC+ enrollment will depend on payer participation

As practices prepare to apply to participate in the Comprehensive Primary Care Plus program on July 15, Wanda Filer, MD, MBA, president of the American Academy of Family Physicians, said the first priority will be to find out which payers will be partnering with the new initiative.

Announced by CMS in April as a new model for primary care delivery and payment through the Affordable Care Act, Comprehensive Primary Care Plus (CPC+) promises to be the largest push yet to move away from fee-for-service care, and toward a value-based system. In anticipation, Filer said in an interview that the AAFP has been busy reaching out to payers, encouraging them to sign on to the program, as their participation will be key to its success.

“What we know around the country is most family physicians have a minimum of seven to 10 payers, and if I’m a family doctor in one market, and only one payer decides they want to do this, I’ll still have the other six payers that want me to do business as usual, and that’s not feasible,” Filer told Healio Family Medicine. “If I am going to transform my practice with all the necessary work, and hiring new people, I need everyone on board. Everyone’s got to be aligned to say, ‘Yes, this makes sense for the patients, it makes sense for the payers and it makes sense for the practice.’ And, frankly, it’s what makes sense for this country, because it’s a way to start reducing unnecessary duplicates of care.”

The new CPC+ model builds on the previous Comprehensive Primary Care program, which launched in late 2012 and was made available to approximately 500 practices in seven markets around the United States.

Under both tracks of the new model, primary care practices would be required to:

  • Support patients with serious or chronic diseases achieve their health goals;
  • grant 24-hour access to care and health information for patients;
  • provide preventive care;
  • engage patients and their families in their own care; and
  • collaborate with hospitals and specialists to better coordinate care.

Practices in Track 2, in addition to the above, would also be required to deliver more comprehensive services for patients with complex medical and behavioral health needs, including an assessment of their psychosocial needs and an inventory or resources to support those needs.

In addition, as an incentive for providing high-quality care, practices in both tracks would receive up-front payments that they would either keep or be forced to repay based on performance on preset metrics.

CMS accepted proposals from payers regarding CPC+ from April 15 through June 1, and will select 20 regions throughout the United States in which to roll out the new model based on payer interest. In all, CMS hopes to introduce CPC+ in 5,000 practices, including 20,000 physicians and clinicians serving 25 million patients.

CMS has yet to announce those 20 regions, but AAFP Senior Public Relations Strategist Leslie Champlin said CMS is expected to make their decisions public sometime this week, prior to July 15. Physicians will be able to apply to partner with the new program until Sept. 15.

Representatives for CMS did not respond to requests for comment.

“The first priority is to figure out who the payers are going to be, and so our focus really is reaching out to the major payers,” Filer said. “And then once we figure out who those payers are going to be, and what those 20 new regions are going to be, then we will have a sense of which practices we’re going to reach out to, in terms of giving support. We kind of have to put the cart before the horse, if you will.” – by Jason Laday

As practices prepare to apply to participate in the Comprehensive Primary Care Plus program on July 15, Wanda Filer, MD, MBA, president of the American Academy of Family Physicians, said the first priority will be to find out which payers will be partnering with the new initiative.

Announced by CMS in April as a new model for primary care delivery and payment through the Affordable Care Act, Comprehensive Primary Care Plus (CPC+) promises to be the largest push yet to move away from fee-for-service care, and toward a value-based system. In anticipation, Filer said in an interview that the AAFP has been busy reaching out to payers, encouraging them to sign on to the program, as their participation will be key to its success.

“What we know around the country is most family physicians have a minimum of seven to 10 payers, and if I’m a family doctor in one market, and only one payer decides they want to do this, I’ll still have the other six payers that want me to do business as usual, and that’s not feasible,” Filer told Healio Family Medicine. “If I am going to transform my practice with all the necessary work, and hiring new people, I need everyone on board. Everyone’s got to be aligned to say, ‘Yes, this makes sense for the patients, it makes sense for the payers and it makes sense for the practice.’ And, frankly, it’s what makes sense for this country, because it’s a way to start reducing unnecessary duplicates of care.”

The new CPC+ model builds on the previous Comprehensive Primary Care program, which launched in late 2012 and was made available to approximately 500 practices in seven markets around the United States.

Under both tracks of the new model, primary care practices would be required to:

  • Support patients with serious or chronic diseases achieve their health goals;
  • grant 24-hour access to care and health information for patients;
  • provide preventive care;
  • engage patients and their families in their own care; and
  • collaborate with hospitals and specialists to better coordinate care.

Practices in Track 2, in addition to the above, would also be required to deliver more comprehensive services for patients with complex medical and behavioral health needs, including an assessment of their psychosocial needs and an inventory or resources to support those needs.

In addition, as an incentive for providing high-quality care, practices in both tracks would receive up-front payments that they would either keep or be forced to repay based on performance on preset metrics.

CMS accepted proposals from payers regarding CPC+ from April 15 through June 1, and will select 20 regions throughout the United States in which to roll out the new model based on payer interest. In all, CMS hopes to introduce CPC+ in 5,000 practices, including 20,000 physicians and clinicians serving 25 million patients.

CMS has yet to announce those 20 regions, but AAFP Senior Public Relations Strategist Leslie Champlin said CMS is expected to make their decisions public sometime this week, prior to July 15. Physicians will be able to apply to partner with the new program until Sept. 15.

Representatives for CMS did not respond to requests for comment.

“The first priority is to figure out who the payers are going to be, and so our focus really is reaching out to the major payers,” Filer said. “And then once we figure out who those payers are going to be, and what those 20 new regions are going to be, then we will have a sense of which practices we’re going to reach out to, in terms of giving support. We kind of have to put the cart before the horse, if you will.” – by Jason Laday