Category: News & Events
April 29 2016
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Recently, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new, five-year advanced primary care medical home model that will begin Jan. 1, 2017. The Comprehensive Primary Care Plus (CPC+) model represents the adoption of new payment mechanisms that incentivize primary care practices to invest in clinical practice improvements and payments for Medicare beneficiaries around comprehensive care management. The model is built on the foundation of the Comprehensive Primary Care (CPC) initiative, which is scheduled to run through the end of 2016.

Two very significant program elements differentiate CPC+ from prior Innovation Center models and from other CMS delivery and payment system reform efforts, indicating CPC+ is a program to watch as a signal of things to come.

First, CPC+ truly marks one of the most significant and advanced collaboration efforts CMS has launched that will help move the whole industry in a common direction of delivery and payment system reform. Recognizing true system reform requires more than just changes to Medicare, CMS is strongly pushing for collaboration with all types of payers - including commercial private health plans, state Medicaid fee-for-service (FFS) and Medicaid managed care plans programs, self-funded payers and other payers - to engage in systematic clinical practice improvements for primary care. CMS continues to strive to reduce friction and distraction for providers attempting to meet payer specific measurement.

For example, CMS recently entered into a collaboration with the Association of Health Insurance Plans (AHIP) in the Core Quality Measures Collaborative, which seeks to curate a common set of clinical quality measures in a framework that can be adopted by all payers who have policy interests in clinical quality measurement.

In the development and formation of CPC+, CMS will establish up to 20 regions across the country where primary care practices can participate in the model program. CMS will select regions based on where payers most strongly indicate their desire to undertake payment policies. The policies must incent primary care practice improvements, adopt health information technology and pay for comprehensive care management as a specific benefit of their health insurance products. The selected regions will contain the highest penetration rate of covered lives represented by payers who express interest.

Second, CPC+ is the most compelling call by CMS to date for the adoption and use of health IT, surpassing even Meaningful Use (MU). In CPC+, primary care practices can participate in two tracks (named Track 1 and Track 2). The tracks have different requirement levels, with Track 2 targeted for more advanced and technologically-enabled practices. Both tracks require the adoption and use of 2015 edition certified electronic health record technology (CEHRT) by Jan.1, 2018, which is consistent with the current timeline for the start of MU Stage 3. But the requirements for use of health IT do not stop there. CMS is adopting several additional program requirements that mark new territory under any CMS program to date:

  1. For Track 2, CMS requires the adoption of additional criteria beyond the scope of CEHRT as certified product requirements specifically tied to MU.
  2. Track 2 practices must have commitment from their health IT suppliers. The supplier must be willing to support the practice to meet the health IT requirements for Track 2 by either optimizing the practice’s current electronic health record or by providing the practice with other additional health IT capabilities within 24 months of the launch of the CPC+ program.  
  3. Health IT suppliers that will support Track 2 participants must enter into memorandums of understanding with CMS.

CMS will first solicit payer proposals beginning this month.  Once the CPC+ regions are selected and announced in late June or early July, practices may apply beginning in July 2016.

Cerner welcomes what we believe is the most significant step CMS has ever taken to embody the use of health IT to support clinical practice delivery improvements. Cerner continues to be committed to our clients’ success in responding to CMS program requirements and advancing delivery and payment system reform.

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