The Centers for Medicare & Medicaid Services (CMS) announced this week that Arkansas has been selected as one of 14 regions nationwide where primary care practices can participate in a new five-year multi-payer payment model called Comprehensive Primary Care Plus (CPC+). The model will launch in January.
Practices that serve Medicare patients (ages 65-plus) can apply through Sept. 15 for the public-private partnership program.
According to CMS, with CPC+, Medicare, state Medicaid agencies and private insurance companies partner to support primary care practices, moving the health care system away from a one-size-fits-all, fee-for-service model.
Dr. Lonnie Robinson of the Regional Family Medicine Clinic in Mountain Home explained that CPC+ rewards physicians for quality of care rather than quantity of care — how many patients they saw in a day — as the old payment model did.
Brandi Hinkle, deputy chief of communications for the Arkansas Department of Human Services, described CPC+ as the "second generation" of the Comprehensive Primary Care initiative (CPCi) that was established in late 2012. CPC+ is replacing CPCi.
Robinson said his practice didn't make it into the CPCi program because it hadn't yet received a certain certification it has now. He said the purpose of both programs is to "help doctors slow down and take better care of patients and get paid well to provide better quality care."
Robinson said his clinic plans to apply for CPC+. Up to 5,000 practices, which collectively service 3.5 million patients, could be selected for the program, which counts insurers like Arkansas Blue Cross & Blue Shield, Arkansas Superior Select, Arkansas Health & Wellness Solutions, QualChoice and HealthSCOPE Benefits among its partners.
Two Models, One Goal
Hinkle said CPC+ aligns with another model already in use for Medicaid patients called Patient-Centered Medical Home (PCMH). PCMH refers to electronic health records and other information being shared rather than "siloed" with a particular doctor.
Hinkle said both models have similar metrics and reporting requirements, ensuring that both Medicare and Medicaid patients receive care of the same quality. Practices that provide care for Medicaid patients can apply to participate in PCMH through Oct. 31, she said.
In CPC+ and PCMH, a patient’s primary care doctor is the "quarterback" and all other doctors and health care providers treat the patient as a team, Hinkle said.
"It's kind of whole-person health care...It's more inclusive for individuals' treatment of acute illnesses and helps them be better prepared to take ownership of their own health care," she said. "So they have 24 hours a day, seven days a week access by phone if they're having a problem."
Practices participating in CPC+ will be paid an upfront, per patient, per month fee that helps them offset technology costs and other expenses related to meeting requirements, such as having a person available to patients by phone 24/7, Hinkle said.
She said these quality-focused models help the state spend its Medicare and Medicaid dollars "more wisely" and discourage people who have never had insurance from showing up at emergency rooms for treatment when they could get better care from a primary care physician — who has their medical records at hand — the next day.
For the last few years, practices enrolled in the model for Medicaid patients were given upfront payments and the state, as it saved money on health care, distributed money back to practices, Hinkle said. She said she didn't know yet whether the same would happen with CPC+.
Robinson said the CPC+ would not include shared savings, and that only one market, Tulsa, achieved shared savings under the previous CPCi model.
Hinkle said CPC+ has two tracks.
Track 1 will function as a "starter" track for practices that didn't participate in the first-generation CPCi. Track 2 would be more "rigorous," with greater requirements for practices to meet but also higher payments, she said.
The average payment for Track 1 practices will be $15 per Medicare patient per month, Hinkle said. According to CMS, in Track 1, practices will be paid a monthly fee in addition to regular Medicare fee-for-service payments.
In Track 2, practices will receive the monthly fee plus a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments.
Robinson said practices in Track 2 could receive up to $28 per Medicare patient per month.
CMS said practices in both tracks will be given performance-based incentive payments that they will either keep or have to pay back to CMS based on whether they meet certain quality and use metrics.
CMS said the Patient Protection and Affordable Care Act allows for the testing of innovative payment and service delivery models, such as the CPC+ model, to move the health care system toward one that rewards clinicians based on the quality, not quantity, of care they provide.
CPC+ is part of a broader strategy to improve the health care system by paying providers for what works, unlocking health care data and finding new ways to coordinate and integrate care to improve quality, CMS said. It supports the federal government’s goal to have 50 percent of traditional Medicare payments going through alternative payment models by 2018; and 30 percent of those payments already do this.