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CMS Quality Focus Turns to Primary Care

May 23, 2016:

In April, the Centers for Medicare and Medicaid Services (CMS) announced another initiative under the Affordable Care Act aimed at tying payment to patient outcomes while making care more comprehensive and tailored to individual patient needs. This time, the initiative focuses on primary care and may involve as many as 20,000 physicians and clinicians in up to 5,000 practices, and 25 million patients over the course of five years. This makes it the largest multipayer program the agency has undertaken to date.

This so-called CPC+ initiative builds on lessons learned with the Comprehensive Primary Care program started in 2012, including redesigning the way care is delivered, requirements of health information technology, insights on practice readiness, and sharing claims data with practices. The new model, slated to begin in January 2017, will partner Medicare with commercial payers and state health insurance plans to help practices provide “advanced” primary care. The “advanced” element incorporates five components:

• Access and continuity: Services are accessible and responsive to patients. In-person hours better meet patients’ needs, and patients can take advantage of 24/7 telephone or electronic access to services or health information.

• Care management: Practices provide proactive, relationship-based care management services to patients at highest risk to improve outcomes.

• Comprehensiveness and coordination: Care is comprehensive, meaning that practices can meet most of each patient’s physical and mental health care needs, including prevention. Practitioners also coordinate care across the health care system, including specialty care and community services, and provide patients with timely follow-up after emergency room or hospital visits.

• Patient and caregiver engagement: Care is patient-centered, treats patients and family members as core members of the care team, and actively involves patients in designing care that best meets their needs.

• Planned care and population health: Quality and utilization of services are measured and data analyzed to pinpoint where care can be improved and to help practices develop new capabilities.

Participating practices will be placed in one of two payment tracks, depending on their capabilities. Track 2 practices will be expected to provide more comprehensive services than track 1 participants to patients with more complex medical and behavioral health issues.

Data on cost and utilization will be vital in helping practices meet their goals. Toward this end, vendors of those in track 2 will have to sign a memorandum of understanding with CMS vowing to support the improvement of practices’ health IT.

CMS will accept payer proposals to partner in CPC+ through June 1, 2016. It will accept practice applications in the determined regions from July 15 through September 1, 2016.


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