Several large commercial payers, including Aetna, Anthem, and UnitedHealthcare will participate in Medicare's two-track successor to the Comprehensive Primary Care initiative.
Comprehensive Primary Care Plus, Medicare's far-reaching program promoting the use of patient-centered medical homes at primary care practices, passed its first milestone this week.
The Centers for Medicare & Medicaid Services Monday identified 14 payer regions and the agency's payer partners in each region. Primary care practices have until Sept. 15 to submit applications to participate in the program, which is slated to launch in January 2017.
The 14 CPC+ payer regions feature 10 statewide regions: Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee. Ohio is a statewide payer region for CPC+ but shares its region with Northern Kentucky.
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The three other CPC+ payer regions are the Greater Kansas City Region in Kansas and Missouri, the North Hudson-Capital Region of New York, and the Greater Philadelphia Region of Pennsylvania.
CMS has enlisted 57 payer partners to help launch CPC+ in January, according to a CPC+ fact sheet.
In addition to Medicare and Medicaid, several large commercial payers are participating in CPC+, including Aetna, Anthem, Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Michigan, Horizon Blue Cross Blue Shield of New Jersey, Tufts Health Plan, and UnitedHealthcare.
The regions were selected by CMS based on payer interest and coverage. "By aligning Medicare, Medicaid, and private insurance, CPC+ moves the healthcare system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes," CMS said in a media release.
In April, CMS announced plans to expand the agency's patient-centered medical home pilot program for primary care, rebranding the effort from Comprehensive Primary Care (CPC) to CPC+.
As many as 5,000 primary care practices may participate in CPC+, which is slated to run over a five-year period beginning in January 2017.
CPC was launched in late 2012. As of October 2015, more than 400 primary care practices were participating.
From a clinical perspective, CPC+ is designed to help primary care practices achieve several objectives, according to Monday's press release: boosting care for chronically ill patients, giving patients 24-hour access to medical services and information, providing preventive care services, engaging patients and families as clinical partners, and boosting care coordination.
"CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices," said Patrick Conway, MD, 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 healthcare system."
Two Tracks
CPC+ has two tracks for physician practices. Track 1 features a relatively simple financial model and less ambitious clinical goals than Track 2.
Highlights of the Track 1 model include physician practices receiving a per beneficiary per month (PBPM) care management fee ranging from $6 to $30. In addition, a performance-based payment incentive as high as $2.50 PBPM will be paid to primary care practices at the beginning of a CPC+ performance year.
The Track 2 model includes a PBPM care management fee based on a five-tier risk-stratification scale. The lowest four tiers mirror the risk-stratification scale for Track 1, with fees ranging from $9 to $33.
In the fifth tier, physician practices can earn a $100 PBPM fee for treating high-risk patients. In addition, a performance-based payment incentive as high as $4 PBPM will be paid to primary care practices at the beginning of a CPC+ performance year.