Payment & Delivery Models

New model of care offers MACRA advantage

Applications are due on Sept. 15 for the Centers for Medicare and Medicaid Services (CMS) five-year primary care medical home model, Comprehensive Primary Care Plus (CPC+). This model builds on experience with an ongoing five-year pilot model by making significant improvements that could help participating physician practices succeed—and it could also help your practice during the upcoming Medicare Access and CHIP Reauthorization Act (MACRA) transition.

Under MACRA, physicians can either participate in the new Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM). Qualifying APM participants are exempt from MIPS and earn five percent bonus payments each year, on top of the additional funding they can receive from the APM itself. One way to qualify for the Advanced APM track is to apply for CPC+.

CPC+ is a five-year primary care medical home model that aims to provide more flexibility and support than is typically available in fee-for-service, especially for non face-to-face services such as proactive patient outreach, care coordination and development of treatment plans. Up to 5,000 practices will be selected to participate.

The AMA is strongly encouraging interested practices to submit applications during the short application period which closes on Thursday, Sept. 15, giving physicians just six weeks to apply. Submit a CPC+ application via the online portal by 11:59 p.m. Eastern time that day. CMS has no plans to allow new applicants later in the five-year period.

The advantages of new models of care

“Physicians like the upfront prospective payment as well as the potential for shared savings bonuses,” said William Golden, MD, medical director of Arkansas Medicaid, who played an essential role in the original pilot as well as the development of a statewide medical home in Arkansas. “It is a highly attractive model that is resulting in greater team-based care and, in many practices, better morale for the doctors, nurses and staff.”

One of the major differences between the pilot and CPC+ is that shared savings under the pilot were regional, Dr. Golden said. “There were seven regions that got CPC, and all the docs in that region had to reach shared savings to get bonuses. It was very hard for a region to qualify.”

In CPC+, the pool approach is out, the bonuses are paid up-front, and performance will be driven at the practice level, he said. “The opportunity for high-performing practices to earn bonuses is much greater.”

“CPC+ lets physicians focus more on chronic disease management and prevention,” Dr. Golden said. “This new model incentivizes you to spend more time with the chronically ill and lets you manage you population in a much more efficient way without necessarily having them come into the office.”

“It encourages phone management, televideo and alternative care,” he said. “It also encourages trying to avoid use of the emergency department … you’re really responsible for the outcomes of your panel.”

“I think the patients have enjoyed it,” he said. “It takes away a lot of the overhead pressures in a busy primary care practice and it encourages alternative visit approaches and, frankly a lot of docs are saying, ‘This allows me to practice medicine in the way I wanted to and the previous reimbursement model didn’t let me.’”

“Many of the practices have welcomed this change in orientation, they really like this way of doing business,” Dr. Golden said. “It means less burnout because it is a more targeted use of their time.”

CPC+ is a multi-payer model, so other payers will join Medicare in making monthly care management and performance-based payments to participating physician practices. Learn more about the 14 CPC+ regions and provisionally selected payers.

CMS has offered several resources for practices that choose to apply. Get your questions answered in the Practice FAQs. Register for one of the 20 upcoming CPC+ Practice Open Door Forums in August and September. Watch the CPC+ Video Series to get an overview of CPC+ payment innovations and care delivery transformation. Download the CPC+ toolkit: CPC+ In BriefCPC+ Care Delivery Transformation Brief, and CPC+ Payment Innovations Brief and Case Studies

Learn more about APMs