In an effort to unlock healthcare data and move to value-based payment models, the Centers for Medicare and Medicaid Services today launched what it is calling its largest-ever initiative to transform and improve primary care in the United States, potentially impacting more than 20,000 clinicians and 25 million patients nationwide.

Called the Comprehensive Primary Care Plus (CPC+) model, CMS says the new initiative is meant to improve healthcare quality and cost, while enabling physicians and patients to have more control over care delivery. Specifically, the five-year CPC+ model is aimed at providing better health outcomes and paying doctors for achieving those results.

As many as 5,000 primary care practices will participate in one of two tracks, with incrementally advanced care delivery requirements and payment options. Healthcare information technology will play an integral role in both tracks, which are designed to give patients 24-hour access to care and health information.

“Optimal use of health IT and a robust learning system will support [physicians] in making the necessary care delivery changes and using the data to improve their care of patients,” an announcement from CMS stated.

Pediatrician Lanre Falusi examines an infant's ear in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland
Pediatrician Lanre Falusi examines an infant's ear in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland Bloomberg Photo

In addition, vendors for Track 2 practices will sign a memorandum of understanding (MOU) with CMS outlining their commitment to support the enhancement of HIT capabilities. “These partnerships will be vital to practices’ success in the care delivery work and align with the Office of the National Coordinator for Health IT priority to ensure electronic health information is available when and where it matters to consumers and clinicians,” the CMS statement said.

CMS will accept practice applications to participate in CPC+ for as many as 20 regions nationally from July 15 through September 1. Practices in both tracks will receive upfront incentive payments that they will either keep or repay based on their performance on quality and utilization metrics. However, Track 2 practices also will receive a monthly care management fee and, instead of full Medicare fee-for-service payments for evaluation and management services, will receive a hybrid of reduced Medicare fee-for-service payments and upfront comprehensive primary care payments for those services.

The experiment will include entities other than providers. Under the CPC+ model, Medicare will partner with commercial and state health insurers to support practices in delivering advanced primary care. CMS says it will also enter into an MOU with select payers to document a shared commitment to align on payment, data sharing and quality metrics. CMS will accept payer proposals to partner in CPC+ from April 15 through June 1.

“By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists, we can continue to build a healthcare system that results in healthier people and smarter spending of our healthcare dollars,” said Patrick Conway, MD, CMS deputy administrator and chief medical officer.

Additional information about the CPC+ model is available here.

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