Practices planning to participate in the Centers for Medicare and Medicaid Services’ Comprehensive Primary Care Plus program must rely heavily on health information technology to be successful.

And for some physicians, time is growing short to get ready for the program known by the acronym of CPC+, an expanded medical home model based on accountable care and first announced in April. CMS on August 1 announced applications now are available to participate in the program, set for 14 regions that cover all or parts of 16 states.

CPC+ is a payment model to incent physicians and consumers to use information technology and the data it generates to improve care of patients with serious or chronic conditions. Part of the enticement will be higher government and private payer reimbursement based on demonstrated improvements in quality and outcomes, in addition to regular Medicare fee-for-service payments.

There are two tracks to the CPC+ program.

Track 1 is designed to aid physicians in expanding capabilities to deliver more comprehensive primary care. They can receive a Medicare care management fee of $15 per beneficiary per month and a performance-based monthly payment of $2.50 per beneficiary per month. Practices will get the incentive payments at the start of a performance year, but practices that don’t meet quality and utilization thresholds may have to return those incentive payments to CMS.

Track 2 is for practices ready to expand their IT capabilities to support patients with complex needs. These practices are eligible for a monthly average Medicare management fee of $28 per beneficiary, which includes a $100 care management fee for patients with the most complex needs.

The intent of the program is to incentivize physicians to foster higher engagement with patients and their families by providing 24-hour access to health information and, in some cases, medical care, identifying at-risk individuals and offering preventive care, and improving the coordination of care among provider organizations. CMS will give providers data on costs and utilization to support them in making changes in how care is delivered.

Much also is expected of healthcare software vendors, which will need to deliver the population health management tools, health information exchange services, data analytics and home-based monitoring products, along with electronic health records that support the other tools. Practices in Track 2 must have letters of support from their vendors outlining commitments to enhance their IT capabilities.

Michael Mytych
Michael Mytych

CPC+ will stretch physician capabilities and compel them to make new investments in health information technologies, says Michael Mytych, principal at Health Information Consulting, which specializes in the EHR and HIE vendor selection processes.

The EHR meaningful use program significantly increased the number of physicians using EHR/HIE software, but those physicians focused primarily on meeting MU requirements rather than meaningfully using the information now available in their systems.

With the CPC+ program, providers now will have to start using HIE functions in their EHR or via outside HIE vendors far more than they have in the past, Mytych notes. They’ll also need to use data to track patient compliance on how well they manage their own care, and on patient satisfaction—two tasks that are fundamentally new for many providers.

In short, participating physicians are expected to redesign their practices to support improved access and care continuity, care management, comprehensiveness and coordination, patient and caregiver engagement, planned care and population health management. The CPC+ is not for the timid who are resistant to significant changes in care delivery, Mytych contends.

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