Comprehensive Primary Care Plus Case Study

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INTRODUCTION:
Comprehensive Primary Care plus is a five-year model that will begin in January 2017. CPC+ is an advanced primary care medical home model that aims to ensure care delivery design through a regionally based multi-payer payment reform. CPC+ includes two primary care practice tracks to deliver better care and improve health outcome. In the first track, the CMS would pay a risk adjusted monthly payment for each Medicare beneficiary’s care management services, in addition to fee for service for primary care visits.
In the second track, physician practices will receive average Medicare fee-for service payments and more generous upfront care management payments. This “hybrid” payment model would break the cycle of traditional face to
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Practices that do not meet the requirements would have to repay all or a portion of the prepaid amount, keeping practices “at risk” for the amounts prepaid. The quality component will be based on performance on electronic clinical quality measures (eCQM) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) metrics.
ACCESS TO CARE:
When patients have access to primary care services, visits to emergency rooms and urgent care facilities can be avoided. Ensuring continuity of care with consistent providers and care team members also aims to build a trusting relationship between the patient and caregiver resulting in greater patient engagement.
CPC+ ensures that patients have 24/7 access to a care team practitioner with real time access to Electronic Health Records (EHR). It also organizes care by practice-identified teams responsible for a specific, identifiable panel of patients to optimize continuity. Comprehensiveness and access to coordinated care are required for better health outcomes and lower overall utilization and costs. The model offers alternative visits to reduce berries to timely coordinated care such as e-visits, phone visits, and group
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Care Management Fees (CMF): Based on risk scores for attributed beneficiaries, practice receives average per beneficiary per month (PBPM) on a quarterly basis.
2. Performance Based Incentive Payment: Paid prospectively on an annual basis; must meet quality and utilization metrics to keep incentive payment. The payment is based on A) utilization metrics obtained by HEDIS standards, and B) clinical quality/patient experience performance obtained by Consumer Assessment of Healthcare Providers and Systems (CAPHS) survey.
3. Underlying Payment Structure: Regular Medicare fee for service payment continues for track 1, while track 2 practices would be paid prospectively on a quarterly basis by Comprehensive Primary Care Payments (CPCP), which will be paid in a lump sum on a quarterly basis.

Political Feasibility:
CPC+ enables better population health management and meaningful practice design for patient care coordination. Primary care practices benefit from multi payer unity in program design, rather than being pulled in various directions by multiple payment models, and quality

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