CMS’s new primary care payment model represents an opportunity for physicians practices experienced in care redesign to be compensated for those efforts. It signals to all groups that it’s time to get serious about improving outcomes.
Major physician groups are applauding the Centers for Medicare & Medicaid Services’ announcement last week about its Comprehensive Primary Care Plus (CPC+) payment model, the new-and-improved successor to its CPC program.
Given the investments required of medical groups to transform their practices into patient-centered medical homes, it’s of little surprise that organizations such as the American Medical Association, American Academy of Family Physicians, and American College of Physicians generally welcome the opportunity to be compensated for their efforts, and with the flexibility to do so via one of two tracks.
On April 19, CMS conducted a webinar to describe how the program will affect participating practices. Laura Sessums, MD, the CMS Division of Advanced Primary Care director, said “CPC+ will offer practices many benefits: the ability to provide enhanced care for patients and improve their outcomes, engagement in a robust learning community of other practices working hard on care delivery redesign, and involvement with payers providing aligned payment, quality measurement, and payer data sharing.”
While many details about the five-year, multi-payer program remain forthcoming, Shari Erickson, vice president of government affairs and medical practice at the ACP, has already been getting calls from members (especially those participating in the soon-to-sunset CPC program) looking to learn more. “They want to know how they can encourage their local payers to become engaged or continue to be engaged with CMS on this project,” she says.
With room for 5,000 practices (2,500 in each track) to enroll in CPC+, Erickson expects that many groups experienced with medical-home related initiatives will dive in.
Minimum Requirements
Applicants must meet minimum requirements to be in the running at all. “To participate in CPC+, practices must enter the model with some experience in care delivery redesign beyond that seen in traditional primary care,” Sessums said.
“This experience will be critical to ensuring the practices have the capability to do the work of the model and achieve its aims. We expect that practices applying to either of the two tracks will have some experience with improving patient access to care, with defining their patient population as a whole, and quality improvement.”
Practices in both tracks will be expected to carry out five primary care functions or “corridors of action,” Sessmus said; Track 2 practices will do so more intensively:
- Access and continuity
- Care management
- Comprehensiveness and coordination
- Patient and caregiver engagement
- Planned care and population health
More information about these functions should be available on the CPC+ website later this week.
Readying for Value-Based Pay
Medical groups that have not yet gained proficiency in these elements, however, can still benefit from studying CPC+ specifics, Erickson says.
“For those practices that maybe aren’t able or ready to get into this project, it paints a clearer picture of what they can expect from Medicare as MACRA rolls out,” she says. “Even if this project isn’t determined initially to be an alternative payment model, it gives us a pretty good idea what CMS is thinking should be in an APM, particularly for primary care.”
According to this week’s webinar, CMS has not yet determined how CPC+ and MACRA will intersect.
Nonetheless, practices that haven’t begun readying themselves for value-based reimbursement in general need to start, according to Pamela Ballou-Nelson, RN, MSHP, PhD, PCMH, CCE, a senior consultant with the Medical Group Management Association.
“All of the payers are going to be moving to some sort of value-based model of reimbursement, and it will be based on clinician efficiency, which will be both quality oriented for patient outcomes and also dependent upon clinical improvements,” she says.
Truly improving outcomes and reducing hospitalizations for patients will hinge not just on what happens inside the practice, but also beyond, Ballou-Nelson says. In particular, practices will need to get better at activating patients to adopt healthy behaviors and collaborating with community resources to address social determinants of health.
CPC+ does indeed focus heavily on meeting patients’ social and behavioral health needs. In fact, Track 2 practices will be required to have a process to link patients to community resources, Sessums said.
In reality, this work may be harder than it sounds, notes Ballou-Nelson. She gives an example of a community in Chicago whose bus company provided residents with free transportation to doctors’ appointments, but the service went unused and was on the verge of being discontinued until a practice finally began asking patients why they weren’t using it.
It turned out that patients with mobility problems or carrying oxygen needed additional help getting from door to door. When the practice placed volunteers on the bus to assist patients, uptake soared and the patients stopped missing appointments.
Optimism Around Vendor Engagement
Time is also up for practices that purchased cheap electronic health record systems while waiting to see whether the trend would stick, Ballou-Nelson says. At a minimum, practices need to invest in EHRs that are interoperable and capable of tracking the data that their contracts require.
Using an EHR is required for participation in either track of CPC+, though only Track 2 practices will have to submit a letter of support from a healthcare IT vendor that outlines its commitment to boost advanced healthcare IT capabilities to increase practices’ comprehensiveness of care.
CMS does not prescribe how that HIT enhancement be achieved, however, only that it meets the needs of the practice team to achieve the CPC+ objectives.
“That seems encouraging because one of the frustrations our members have had with EHRs as a whole is that many of the vendors have needed to build their EHRs to meet regulatory requirements of Meaningful Use and documentation requirements of E/M coding,” the ACP’s Erickson says. “And with all of that work [vendors] don’t really make any space, so to speak, to more specifically build out what practices need on the ground based on the way practices actually function.”
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.