HealthBlawg

David Harlow's Health Care Law Blog

    • Twitter
    • Facebook
    • LinkedIn
    • RSS
    • Email
  • About
  • Archives
  • Podcast
  • Press
  • Awards/Reviews
  • HIPAA
  • HCSM

Comprehensive Primary Care Plus – Medicare Doubles Down

April 27, 2016

CMS, through its Centers for Medicare and Medicaid Innovation (CMMI), is rolling out a refined version of an innovation model that is just winding down its four-year run. Per CMMI, the Comprehensive Primary Care (CPC) initiative

is a four-year multi-payer initiative designed to strengthen primary care. Since CPC’s launch in October 2012, CMS has collaborated with commercial and State health insurance plans in seven U.S. regions to offer population-based care management fees and shared savings opportunities to participating primary care practices to support the provision of a core set of five “Comprehensive” primary care functions. These five functions are: (1) Risk-stratified Care Management; (2) Access and Continuity; (3) Planned Care for Chronic Conditions and Preventive Care; (4) Patient and Caregiver Engagement; (5) Coordination of Care across the Medical Neighborhood. The initiative is testing whether provision of these functions at each practice site — supported by multi-payer payment reform, the continuous use of data to guide improvement, and meaningful use of health information technology — can achieve improved care, better health for populations, and lower costs, and can inform future Medicare and Medicaid policy.

Comprehensive Primary Care Plus (CPC+) is slated to go live January 2017. (CPC+ presser, CPC+ RFA, summary of CPC+ IT requirements). Per CMMI,

the five-year CPC+ model will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases to achieve their health goals
  • Give patients 24-hour access to care and health information
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better coordinated care

Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs.

CPC+ will help practices move away from one-size-fits-all, fee-for-service health care to a new system that will give doctors the freedom to deliver the care that best meets the needs of their patients. In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.

A recently published study of the CPC model showed that, after two years, CMS got (statistically speaking) zero bang for its buck. (Follow the link above to Jaan Sidorov’s post about the study and the model on the Population Health Blog; he discussed it with Joe Paduda and me as part of a recent Health Wonk Review on Air Blab). At CMMI, we’re still in “throw it against the wall and see what sticks” mode.

I’ll be discussing the CPC+ model on today’s #hcbiz Tweetchat and Blab with co-hosts Don Lee and Shahid Shah, and PCPCC President Marci Nielsen. Join us live at 12 noon ET on Twitter and at 12:30 on Blab (both accessible via the link live and as a replay; <update> the Blab replay is available right here as well).

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Filed Under: Blab, CMS, EHR, Health care policy, Health Law, Healthcare Innovation, HHS, HIT, Medicare, Physicians, Value Based Purchasing

you might also like:

  1. Medicare & Chronic Care: Feds Clearing Out Underbrush?

  2. The Medical Home: Primary care panacea or the next doughnut hole?

  3. Health Care Innovation: Primary Care is the New Black

« Health Wonk Review is Up – Join Health Wonks on Blab
MIT Hacking Medicine Grand Hack 2016 »

Comments

  1. Holly cassano says

    April 28, 2016 at 5:52 am

    Great post – sorry I couldn’t join yesterday, but am on target for 5/10.

    Looking forward to joining that chat!

    -Holly
    @hollycassano

Follow me on Twitter

David Harlow 💉😷 Follow 42,910 17,570

Mastodon @healthblawg@c.im #HealthCare #MedDevice #Compliance #Privacy @MyOmnipod #HIPAA #digitalhealth #HarlowOnHC #pinksocks Tweets are tweets No more no less

healthblawg
healthblawg avatar; David Harlow 💉😷 @healthblawg ·
5h 1620535759902998528

The Harlow #Healthcare #Innovation Daily #digitalhealth #hcldr #HarlowOnHC #digitalhealth #healthtech

Image for twitter card

Google Research and DeepMind develop AI medical chatbot

digitalhealth.net A new AI-powered medical-specific chatbot developed by Google and DeepMind has shown some potential for clinical applications.

paper.li

Reply on Twitter 1620535759902998528 Retweet on Twitter 1620535759902998528 0 Like on Twitter 1620535759902998528 0 Twitter 1620535759902998528
healthblawg avatar; David Harlow 💉😷 @healthblawg ·
6h 1620524933863378944

ICYMI> Paul Schrimpf, at Prophet Consulting, Driving Health Care Transformation — Harlow on Healthcare https://healthblawg.com/2022/12/paul-schrimpf-prophet-consulting.html?utm_source=twitter&utm_medium=social&utm_campaign=ReviveOldPost #digitalhealth #hcldr #hitsm

Image for the Tweet beginning: ICYMI&gt;  Paul Schrimpf, at Twitter feed image.
Reply on Twitter 1620524933863378944 Retweet on Twitter 1620524933863378944 0 Like on Twitter 1620524933863378944 0 Twitter 1620524933863378944
healthblawg avatar; David Harlow 💉😷 @healthblawg ·
11h 1620445622955278337

Moonshots — StartUp Health https://paper.li/healthblawg/1369855999?read=https%3A%2F%2Fwww.startuphealth.com%2Fmoonshots #hcldr

Reply on Twitter 1620445622955278337 Retweet on Twitter 1620445622955278337 0 Like on Twitter 1620445622955278337 0 Twitter 1620445622955278337
Load More
Follow me on Mastodon

HIPAAtools

Hipaatools

The HIPAA Compliance Toolkit

The Walking Gallery

The Walking Gallery

Quick Links

  • Home
  • Categories
  • Archives
  • Podcast Interviews
  • HIPAAtools
  • HIPAA Compliance
  • Health Care Social Media
  • Speaking
  • In the Press
  • Blogroll

David Harlow

David Harlow

HealthcareNOW Radio

Connect with David

  • Twitter
  • Facebook
  • LinkedIn
  • RSS
  • Email
  • Subscribe
  • Contact
  • Book Me: Speaking
  • About
  • The Harlow Group LLC
Copyright © 2006–2023
HealthBlawg is a publication of The Harlow Group LLC. See Copyright notice and disclaimer.
Fair use with attribution and a link is encouraged. Click for more on David Harlow.
[footer_backtotop text="Back to top" href="#"]