14 regions to be included in CPC+

CMS has announced 14 regions where practices can now apply to participate in the new Comprehensive Primary Care Plus (CPC+) model.

When the five-year primary care medical home model was first announced in April, CMS had said it could be implemented in up to 20 regions. Though the final number of selected areas is smaller, the agency still estimates up to 5,000 practices will participate in the following regions:

1. Arkansas: Statewide
2. Colorado: Statewide      
3. Hawaii: Statewide
4. Kansas and Missouri: Greater Kansas City Region
5. Michigan: Statewide
6. Montana: Statewide
7. New Jersey: Statewide
8. New York: North Hudson-Capital Region
9. Ohio: Statewide and Northern Kentucky Region
10. Oklahoma: Statewide
11. Oregon: Statewide
12. Pennsylvania: Greater Philadelphia Region
13. Rhode Island: Statewide
14. Tennessee: Statewide

CMS says regions were selected based on “payer interest and coverage” because of the program’s multi-payer model, which encourages Medicare, state Medicaid agencies tand commercial insurers to support primary care practices in delivering more advanced care.

“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” said Patrick Conway, MD, CMS deputy administrator and chief medical officer. “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most—serving their patients’ needs when and how they choose.”

The model aims to build off the earlier CPC model, which Conway said in October 2015 had generated $24 million in gross savings across 483 practices, with 90 percent successfully meeting quality targets.

CPC+ specifically aims to assist primary care practices in supporting patients with serious or chronic conditions, giving patients 24-hour access to information on their health and care, delivering preventive care, involving patients and their families in care, and providing better care coordination by working with hospitals and other clinicians.

The model includes two tracks. In Track 1, practices will be paid a monthly fee by CMS in addition to their usual fee-for-service Medicare payments. In Track 2, payment gets more complicated. The monthly fee will still be paid, along with what CMS calls a “hybrid” of reduced fee-for-service payments and “up-front comprehensive primary care payments to allow greater flexibility in how practices deliver care.” Track 2 practices also have to provide more services for patients with “complex medical and behavioral health needs, including assessments of their psychosocial needs. The combination of payment methods was designed to encourage practices to offer enhanced IT services, serve patients with complex needs and offer care outside of in-office visits.  

For both tracks, performance-based incentive payments will be available, though practices will either have to keep or pay back those payments to CMS based on their scores on quality and utilization metrics. Participating practices may also be able to take advantage of addition incentive payments under the new Advanced Alternative Payment Models being implemented as part of the Medicare Access and CHIP Reauthorization Act (MACRA).

CMS had already expanded eligibility for CPC+ before opening up the application process, announcing May 27 that accountable care organizations (ACOs) will be allowed to participate, though ACOs will only be allotted 1,500 of the 5,000 available slots. If more than 1,500 want to join, the agency will hold a lottery to decide which ACOs get into CPC+.

CMS will be accepting CPC+ applications from eligible practices until September 15.