CMS has announced 14 regions in the United States where physicians and practices will be able to apply to participate in its Comprehensive Primary Care Plus program, a new model for care delivery through the Affordable Care Act.
The selected regions include the states of Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Ohio, Oklahoma, Oregon, Rhode Island and Tennessee. Also included are the North Hudson-Capital region in New York, the greater Kansas City area in Kansas and Missouri, northern Kentucky and greater Philadelphia.
According to CMS, CPC+ will be available to approximately 5,000 practices across the selected regions, which were chosen based on payer interest.
Physicians can apply to enroll in the new program through Sept. 15.
“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” Patrick Conway, MD, MSc, CMS deputy administrator and chief medical officer. “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most — serving their patients’ needs when and how they choose.”
The new, 5-year program is a primary care medical home model, and an expansion of CMS’ Comprehensive Primary Care (CPC) initiative, which is scheduled to terminate at the end of 2016. The expanded model is set to begin in 2017. In 2012, CPC rolled out in 500 practices in just seven markets in the United States.
CPC+ creates a two-track system for payments. Track 1 would see CMS pay primary care practices receive a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule. Under Track 2, practices would receive the monthly care management fee, and a hybrid of reduced Medicare fee-for-service payments and upfront comprehensive primary care payments.
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.
Physicians opting for either track will be required to make several changes and updates to their practices to stay eligible. Click here for a detailed breakdown of the changes required for each track.