CMS divulges CPC+ regions: What you need to know

CMS has announced regions for the Comprehensive Primary Care Plus (CPC+) program for Medicare beneficiaries.

Related: New CMS model incentivizes providers toward value-based care

The CPC+ program will launch in 14 regions, including 11 states: Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.

CPC+ is a regionally-based, multipayer care delivery and alternative payment model (APM) that rewards value and quality through an innovative payment structure to support comprehensive primary care. The model will offer two tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices.

Jones

“It’s important for healthcare leaders to understand this new model represents an alternative payment model [APM] which was mandated in the 2015 MACRA legislation-that’s important to remember because APM’s are exempt from the Merit-based Incentive Payment System [MIPS] and could lead to enhanced payments-5% lump sum bonus between 2019 and 2023-and slightly higher fee schedule updates in 2026 and beyond,” according to Randy Jones, senior vice president of Consulting Services (West) at Culbert Healthcare Solutions.

Nichol

The decision to participate in the CPC+ initiative is not only about "chasing an additional 33% in payment reimbursements for tier 1 healthcare costs," according to Peter Nichol, healthcare expert, PA Consulting Group. "A review of practice policies, procedures, and practice guidelines must be conducted. This decision affects every part of your business."

With an open application period from August 1 to September 15, 2016, Nichol says that it’s tempting to participate in this initiative without involving your entire practice.

"That would be a mistake," he says. "It’s essential to gain cross-functional practice engagement. Start by openly asking informed questions to assess readiness."

Some questions to ask yourself include:

• Have we conducted a financial analysis to determine our cash inflows and outflows with the new revenue model?

• Is this decision based on purely financial gains, or does our practice buy into the broader value-based payment model regardless of the financial impact?

• Lastly, how does the transition to value-based care impact our patients?

Another advantage of this model is its recognition of the significant overhead costs associated with the management of complex patients through its risk-adjusted prospective payments, according to Jones.

“Past CMS demonstrations have shown the aggressive chronic disease management and enhanced patient access are critical to bending the cost curve for these patients and those programs cost money,” he says.

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