CMS to Launch Primary Care Initiative to Transform Care Delivery and Payment

CMS to Launch Primary Care Initiative to Transform Care Delivery and Payment

In a bold attempt to leverage various alternative payment model initiatives to move 50% of Medicare payments into alternatives to fee for service by 2018, CMS plans to launch the largest-ever multi-payer program to improve the quality of primary care. The initiative, called the Comprehensive Primary Care Plus (CPC+) program, is scheduled to start next year and builds on CMS’ Comprehensive Primary Care (CPC) initiative, which started in 2012 and will end this year.

The CPC+ is an advanced primary care medical home model in which CMS will partner with payers, both public and commercial, who volunteer to provide the financial support as well as claims data feedback to practices for changing the delivery system in the primary care setting.

CPC+ will be larger than CPC (500 vs. 5,000 practices) and have two tracks with different levels of care management fees. These care management fees should give the practices enrolled in the program the freedom to deliver care to their patients that is traditionally not covered under fee for service. Those that see better health outcomes for their groups of patients, as determined by a set of performance data metrics, will keep all or most of those fees, while practices that fall short will have to repay some of those fees. No longer caged into a pure fee-for-service model, providers can venture out and try approaches that they believe will improve outcomes, including telephone and video consultations, longer office visits, and the addition of more care managers to help patients secure medications, promote adherence, and coordinate care with other doctors.

I was talking to a friend of mine, a medical director at a large primary care practice, when the topic of CPC+ came up. She did not know much about this up-and-coming program so I informed her of how it would allow providers to care for patients in the best way without having to worry about conforming to services billable through fee for service. She was skeptical that the program would work as intended.

But I disagree. Although this single program will certainly not solve all problems in every practice, it is becoming evident that quality is winning over quantity—and it is here to stay. As this message is rippling throughout the health care ecosystem, even drug and device manufacturers are realizing that in order to have a skin in the game, they must prove positive outcome—especially if they are competing in a crowded market.