PWeR Blog

Sign up today for the latest PWeR development announcement!

Modernizing Medicare Version 2017

By: | Tags: | Comments: 0 | April 20th, 2016

Since the beginning of the PWeR News blog, we have discussed that there are two major trends in healthcare; one being the change of payments, and second, the use of technology.

Last week the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced it’s largest initiative ever, to transform and improve how primary care is delivered and paid for in America. “The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices. This effort would encompass more than 20,000 doctors and clinicians, as well as the 25 million people they serve. The initiative is designed to provide doctors with the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.”

The Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.). The care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population. The multi-payer payment redesign will give practices greater financial resources and flexibility to make appropriate investments to improve the quality and efficiency of care, and reduce unnecessary health care utilization. CPC+ will provide practices with a robust learning system, as well as actionable patient-level cost and utilization data feedback, to guide their decision making.

CPC+ is a five-year model that will begin in January 2017.

Strengthening primary care is critical to promoting health and reducing overall health care costs in the U.S. CPC+ builds on the foundation of the Comprehensive Primary Care (CPC) initiative, a model tested through the Center for Medicare & Medicaid Innovation that runs from October 2012 through December 31, 2016. CPC+ integrates many lessons learned from CPC, including insights on practice readiness, the progression of care delivery redesign, actionable performance-based incentives, necessary health information technology, and claims data sharing with practices.

CPC+ will bring together CMS, commercial insurance plans, and State Medicaid agencies to provide the financial support necessary for practices to make fundamental changes in their care delivery. CMS will enter into a Memorandum of Understanding (MOU) with selected payer partners to document a shared commitment to align on payment, data sharing, and quality metrics throughout the five-year initiative. The goal of CPC+ is to improve the quality of care patients receive, improve patients’ health, and spend health care dollars more wisely.

Practices in both tracks will make changes in the way they deliver care, centered on five key Comprehensive Primary Care Functions:

  1. Access and Continuity
  2. Care Management
  3. Comprehensiveness and Coordination
  4. Patient and Caregiver Engagement
  5. Planned Care and Population Health

There will be multiple paths or tracks of the CPC+. The key component is the practice capabilities, the management fee paid (likely to range from $20 to $100 per member per month). Healthcare information technology will also play a key role in both the 24/7 access to the patient for their medical record, and communication to and from their provider. The program will require the commitment from the groups “health IT vendor partner” that it is committed to supporting the practices “advance health IT capabilities.” I think our proselytizing on quality of care’s link to how providers get paid, and the key role health IT must play has been justified.

For years, we have pointed out that if you use technology to link patients to their providers using the same tools to give those patients and consumers a path to improve their health on their own, you can change utilization in a very fundamental way that allows you to spread your primary care resources across a larger panel size. We believe that this model has great potential to change the path of both high healthcare cost in the U.S., as well as provide patients with better healthcare and more control over their own information. The way of practicing healthcare is undergoing a generational transformation, and that is just in time for the influx of 77 million baby boomers retiring as they become eligible for Medicare.

– Noel J. Guillama, President

You must be logged in to post a comment.