On April 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the Comprehensive Primary Care Plus (CPC+) model. The CPC+ model, which builds on the CPC model launched in October 2012, is designed to align Medicare, state Medicaid agencies, and commercial insurance payers to achieve comprehensive, coordinated primary care, especially for patients with complex medical and behavioral health needs.
Primary care practices participating in CPC+ can choose “track 1” or “track 2,” a more innovative model under which practices will be expected to offer enhanced services such as identification of psycho-social needs and resources. Track 1 includes a $15 per patient per month (PMPM) care management fee (on average), a $2.50 PMPM performance incentive payment tied to quality and utilization metrics, and regular fee-for-service payments (including regular FFS evaluation and management (E/M) payments). Track 2 curtails E/M FFS payments but includes a $28 PMPM standard care management fee (on average), a $100 PMPM care management fee for patients with complex needs, a $4.00 PMPM performance incentive payment tied to quality and utilization metrics, and additional provisions on achieving improved care through health IT.
CMS seeks proposals from payers by June 1, 2016 to participate in CPC+. Based on payer proposals, CMS will select geographic regions in which it will implement CPC+, and then ask for proposals from primary care practices in those selected regions from July 15, 2016 to September 1, 2016. CMS estimates that the CPC+ may be implemented in up to 20 regions, may encompass 5,000 primary care practices with more than 20,000 clinicians, and could serve 25 million persons. A five year implementation period for CPC+ is scheduled to begin in January 2017. Additional information from CMS on the CPC+ model is available here and here. Finally, an article on CPC+ in the Journal of the American Medical Association is available here.