On April 11, 2016, CMS announced its launch of the “largest-ever multi-payer initiative to improve primary care in America.”  The effort is titled the Comprehensive Primary Care Plus (CPC+) model, and will build on the Comprehensive Primary Care initiative launched in 2012.  Under CPC+, physicians will be assigned to one of two tracks.  Practices in both tracks will receive a monthly care management fee.  In addition, practices in Track 1 will receive fee-for-service payments under the Medicare Physician Fee Schedule, whereas practices in Track 2 will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for Evaluation & Management services. 

According to CMS, the CPC+ model will help practices transition from the fee-for-service payment model, and will help practices (1) support patients with serious or chronic diseases, (2) give patients 24-hour access to care and their health information, (3) deliver preventive care, (4) engage patients and families in the patients’ care, and (5) work with providers to provide coordinated care. 

All physician practices participating in CPC+ will receive up-front incentive payments.  However, only practices that meet certain quality and utilization metrics would keep these payments.  Physicians will also receive data on cost and utilization to assist in the use of data for patient care. 

Within CPC+, Track 1 is designed for practices that prefer to rely primarily on fee-for-service payments, but would be eligible for a performance-based incentive payment.  Track 2 is designed for practices that use enhanced health IT, provide care for patients with complex needs, and prefer to be paid through a hybrid of fee-for-service and a percentage of expected Evaluation & Management reimbursements.  Practices in Track 2 would receive a higher performance-based incentive payment per beneficiary.  

CMS’s announcement is available here.  The corresponding fact sheet, including application instructions is available here.

Reporter, Igor Gorlach, Houston, +1 713 276 7326,  igorlach@kslaw.com.