On July 18, the Health Collaborative hosted the second regional learning session of the Ohio/ Northern Kentucky cohort of the Center for Medicare and Medicaid Services (CMS) Comprehensive Primary Care Plus (CPC+) program. Held at the Ohio Union on the campus of The Ohio State University in Columbus, OH, approximately 600 practice team members were in attendance; another 200 participated by teleconference.
The full day program provided CPC+ selected practices access to presentations and small breakout discussions designed to help them realize program success. Featured topics included practice transformation in a value-based environment, empanelment and risk stratification, using data for quality improvement, behavioral health integration, and leveraging clinician champion, just to name a few.
Ohio Academy of Family Physicians member and chief medical officer for the Health Collaborative, Richard Shonk, MD, shared that the Ohio/Northern Kentucky region included 562 primary care practices – the largest of all the CPC+ selected regions. In fact, the majority of the practices in the CPC+ program (362 to be exact), represent independent, rural, or small practices. Even more impressive, between 1.5 – 2.0 million patient lives are impacted by Ohio and Northern Kentucky’s participation in CPC+.
Dr. Shonk explained that, “We are all going to learn a whole heck of a lot from each other for long-term sustainability.” Other OAFP members who took part in the conference shared insight into their participation in the CPC+. Mark Couch, MD, a family physician from Vandalia, OH, explained that, “Health care in its present form is unsustainable. A new infrastructure is required to hurdle the obstacles and CPC+ is a consistent format to move the medical neighborhood forward – together.”
OAFP Past President Matt Finneran, MD, elaborated on Drs. Shonk and Couch’s shared sentiments by saying, “Although my practice is a recognized patient-centered medical home in my area, there is still a lot to learn. The financial support is a welcomed recognition of what it takes to provide quality, high value health care at the primary care delivery level. Because of the CPC+ initiative, I’m excited for the future of primary care and particularly family medicine.”
CPC+ is a unique public-private partnership, in which practices are supported by 54 aligned payers in 14 regions in Round 1, and seven payers in four newly selected regions in CPC+ Round 2. This partnership gives practices additional financial resources and flexibility to make investments, improve quality of care, and reduce the number of unnecessary services their patients receive.
CPC+ provides practices with a robust learning system, as well as actionable data feedback to guide their decision making. The care delivery redesign ensures practices have the infrastructure to deliver better care, resulting in a healthier patient population.
- Care Management Fee (CMF): Both tracks provide a non-visit-based CMF paid per-beneficiary-per month (PBPM). The amount is risk-adjusted for each practice to account for the intensity of care management services required for the practice’s specific population. The Medicare fee-for-service (FFS) CMFs will be paid to the practice on a quarterly basis.
- Performance-Based Incentive Payment: CPC+ will prospectively pay and retrospectively reconcile a performance-based incentive based on how well the practice performs on patient experience measures, clinical quality measures, and utilization measures that drive total cost of care.
- Payment under the Medicare Physician Fee Schedule: Track 1 continues to bill and receive payment from Medicare FFS as usual. Track 2 practices also continue to bill as usual, but the FFS payment will be reduced to account for CMS shifting a portion of Medicare FFS payments into Comprehensive Primary Care Payments (CPCP), which will be paid in a lump sum on a quarterly basis absent a claim. Given our expectations that Track 2 practices will increase the comprehensiveness of care delivered, the CPCP amounts will be larger than the FFS payment amounts they are intended to replace.
The OAFP will continue to report on CPC+ practice challenges and successes over the multi-year, transformation period. However, if you have immediate questions about the program, please contact the Health Collaborative or call 513.618.3600.