Comprehensive Primary Care Plus (CPC+) Round 2 Region Announcement

WASHINGTON, May 17 -- The U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services issued the following fact sheet:

Strengthening primary care is critical to promoting high quality, patient-centered care, and reducing overall health care costs in the U.S. The Comprehensive Primary Care Plus (CPC+) (https://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus/)model is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support primary care practices to improve quality, access, and efficiency. The model offers two tracks with different care delivery requirements and payment methodologies to meet the diverse needs of primary care practices.

In 2017, CPC+ Round 1 began in 14 regions, with 53 payers and 2,891 practices. CMS is offering a second round of solicitations for payers to partner with CMS and practices to participate in CPC+ from 2018 to 2022. Following payer applications and selections, the following four regions were selected for CPC+ Round 2:

1. Louisiana: Statewide

2. Nebraska: Statewide

3. North Dakota: Statewide

4. New York: Greater Buffalo Region (Erie and Niagara Counties)

Eligible practices located in these regions may apply to participate in CPC+ Round 2 from May 18, 2017 to July 13, 2017.

CPC+ Round 2 regions were selected based on payer alignment and market density to ensure that CPC+ practices have sufficient payer supports to make fundamental changes in their primary care delivery. CMS has provisionally selected to partner with seven payers in these regions throughout Round 2 of the model. In addition, CMS has provisionally selected five payer partners to provide additional support in certain existing Round 1 regions.

General Model Overview

Model Design

CPC+ is a regionally-based, multi-payer care delivery and payment model that includes two separate tracks. Depending on their care delivery and health IT capabilities, practices may apply to participate in either Track 1 or Track 2 of CPC+. Track 1 is intended for practices that have the health information technology and other basic infrastructure necessary to deliver comprehensive primary care. Track 2 is intended for practices proficient in comprehensive primary care that are prepared to increase the depth, breadth, and scope of medical care delivered to their patients, particularly those with complex needs. CMS expects to select up to 1,000 practices across the new Round 2 regions.

The model requirements (https://innovation.cms.gov/Files/x/cpcplus-practicecaredlvreqs.pdf) ensure that practices in each track will be able to build capabilities and care processes that provide more opportunities for patients to improve their health. Payment redesign (https://innovation.cms.gov/Files/x/cpcplus-methodology.pdf) offers the ability for greater cash flow and flexibility for primary care practices to deliver high quality, patient-centered care and lower the use of unnecessary services that drive total costs of care. CPC+ will provide practices with a robust learning system, as well as actionable patient-level cost and utilization data, to guide their decision making.

Practices in both tracks are required to deliver more patient-centered care, guided by five Comprehensive Primary Care Functions: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health. CPC+ practices innovate on a set of care delivery requirements with the flexibility to make investments to improve quality, access, and efficiency for their patients.

Care Management Fee

CMS provides prospective monthly care management fees (CMFs) to Track 1 and 2 practices. As highlighted in the table below, the Medicare CMFs average $15 per-beneficiary per-month (PBPM) across 4 risk tiers in Track 1. In Track 2, the Medicare CMFs average $28 PBPM across 5 risk tiers, which includes a $100 CMF to support care for Medicare beneficiaries with the most complex needs. Practices may use this enhanced, non-visit-based compensation to support augmented staffing and training needed to meet the model requirements according to the needs of their patient population.

Click here to view the table: (https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-05-17.html)

CPC+ payer partners will also provide non-visit based financial supports to practices based on their own methods.

Comprehensive Primary Care Payments

Track 1 practices continue to receive Medicare fee-for-service payments. In Track 2 of CPC+, CMS is introducing a hybrid of Medicare fee-for-service and "Comprehensive Primary Care Payment" (CPCP). The Medicare CPCP changes the cash flow mechanism for Track 2 practices, promotes flexibility in how practices deliver care traditionally provided face-to-face, and supports practices to increase the depth and breadth of primary care they deliver. Track 2 practices receive a percentage of their expected Medicare payment for Evaluation & Management (E&M) claims payment upfront in the form of a quarterly CPCP along with a reduction in Medicare fee-for-service payments for their billed E&M claims for services furnished to CPC+ beneficiaries.

CPC+ payer partners are expected to make changes to their underlying payment structures in ways that align with the goal of the CPCP and allow practices to deliver care in more patient-centered ways.

Performance-Based Incentive Payment

CPC+ rewards practices using incentive payments based on their performance on patient experience, clinical quality, and utilization measures. The CPC+ performance-based incentive payments paid by Medicare are up to $2.50 PBPM for Track 1 and up to $4 PBPM for Track 2. Performance-based incentive payments are prospectively paid at the beginning of a performance year, but CMS may recoup payments made to the practices if they do not meet thresholds for quality and utilization performance.

CPC+ payer partners are expected to provide practices with their own incentives based on quality, patient experience, utilization, and/or cost of care.

Partners and Participants

Multi-Payer Partnership

CPC+ brings together Medicare and other payers, including commercial insurance plans and Medicaid managed care organizations, in four regions in CPC+ Round 2 to provide the necessary financial support for practices to make significant changes in their care delivery. CMS has provisionally selected to partner with seven payers in Round 2 and invites these payers to enter into a Memorandum of Understanding (MOU) to document a shared commitment to align on payment, data sharing and quality metrics.

Primary Care Practices

CPC+ targets primary care practices with varying capabilities to deliver comprehensive primary care. In order to participate, all CPC+ practices must demonstrate multi-payer support, use Certified Electronic Health Record (EHR) Technology, and have other capabilities. From May 18 to July 13, 2017, practices located within the four CPC+ Round 2 regions may apply to participate in Track 1 or 2.

Health Information Technology (Health IT) Vendors

Comprehensive primary care requires efficient, advanced health IT to support its population-health focus and team-based structure. Practices in both tracks will qualify for the model based, in part, on having met certain health IT requirements, and will be expected to report electronic clinical quality measures at the CPC+ practice site and TIN/NPI level. CMS also expects Track 2 practices to work with vendors to develop and optimize a set of advanced health IT functions. Fifty-three health IT vendors have memorialized their commitment to supporting Track 2 practices and participating in model activities in a Memorandum of Understanding (MOU) with CMS.

Practice Application Process

CMS is soliciting applications via online portal from eligible practices within the four Round 2 regions from May 18 to July 13, 2017 and expects to accept up to 1,000 practices in CPC+ Round 2. Practices may apply directly to the track for which they believe they are ready. However, CMS may ask a practice that applied to Track 2 to participate in Track 1 instead, if CMS believes that the practice does not meet the eligibility requirements for Track 2, but does meet the requirements for Track 1. Practices applying to Track 2 must ask their health IT vendors to write a letter of support that outlines their commitment to supporting the required health IT capabilities under the model.

CMS will randomly assign the eligible practice applicants into an intervention group (Track 1 and Track 2 of the Model) or the control group. Practices randomized into the control group will not receive the CPC+ payments or participate in the learning communities. Practices assigned to the control group will have the opportunity to enter into a control group practice-specific Participation Agreement with CMS and, pursuant to terms of that Participation Agreement, CMS intends to provide compensation for control group practices for their participation in CPC+ evaluation-related activities. CMS expects to promulgate a rule that would allow control group practices may receive favorable scoring under the Improvement Activities category of the Merit-based Incentive Payment System (MIPS), subject to notice and comment rulemaking. More details for control group practices will be announced in late 2017. Practices located in the 14 CPC+ Round 1 regions are not eligible to apply for Round 2.

CPC+ Round 1

Beginning on January 1, 2017, CMS and 53 payer partners aligned to support 2,891 practices of all sizes and ownership structures in 14 regions throughout the country. As a result of the recent Round 2 payer solicitation, CMS has provisionally accepted three new payer partners in existing Round 1 regions, as well as two existing payer partners in additional Round 1 regions, thereby providing Round 1 practices enhanced resources to implement the CPC+ care delivery model.

Practices located in the 14 CPC+ Round 1 regions are not eligible to apply for CPC+ Round 2, as outlined in the table below:

Click here to view the table: (https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-05-17.html)

aGreater Kansas City Region is defined as Johnson County, KS; Wyandotte County, KS; Clay County, MO; Jackson County, MO; Platte County, MO

bNorth Hudson-Capital Region of New York is defined as Albany County, NY; Columbia County, NY; Dutchess County, NY; Greene County, NY; Montgomery County, NY; Orange County, NY; Rensselaer County, NY; Saratoga County, NY; Schenectady County, NY; Schoharie County, NY; Sullivan County, NY; Ulster County, NY; Warren County, NY; Washington County, NY

cOhio-Northern Kentucky Region is defined as all counties in Ohio; Boone County, KY; Campbell County, KY; Grant County, KY; Kenton County, KY

dGreater Philadelphia Region is defined as Bucks County, PA; Chester County, PA; Delaware County, PA; Montgomery County, PA; Philadelphia County, PA

eGreater Buffalo Region is defined as Erie County, NY and Niagara County, NY

Quality Payment Program and CPC+

Tracks 1 and 2 of CPC+ are included on the list of Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP), and this determination was based on medical home model-specific requirements. For payment years 2019 through 2024, clinicians who meet the threshold for sufficient participation in Advanced APMs and who meet requirements, as applicable for 2018 onward, regarding parent organization size are excluded from the Merit-based Incentive Payment System (MIPS) reporting requirements and payment adjustments and may qualify for a five percent APM incentive payment. More information about the QPP and Advanced APMs can be found on the QPP website: https://qpp.cms.gov.

Further Information

For questions about the model or the application process, visit http://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus or email [email protected]

Innovation Center

CPC+ was developed by the Center for Medicare and Medicaid Innovation (Innovation Center), which was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). Congress created the Innovation Center to test innovative payment and service delivery models - including primary care payment and care delivery reform - to reduce Medicare, Medicaid, and the Children's Health Insurance Program expenditures and enhance the quality of care for beneficiaries.