Medicare Announces New Primary Care Pilot Program

CMS selects markets for new primary-care payment initiative

By Virgil Dickson  | August 1, 2016 | ModernHealthcare

The CMS will launch an ambitious primary care quality improvement initiative in four regions and 10 states that include Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.

The markets for the Comprehensive Primary Care Plus (CPC+) initiative were selected based on density and interest shown by practices and payers. Fifty-seven not-yet-named payers will participate. The regions include Kansas City, the North Hudson valley in New York, Philadelphia and Northern Kentucky.

Under CPC+, the CMS and other insurers would pay physicians a monthly fee for patient primary-care visits. The new model aims to improve health outcomes and lower cost not only for Medicare beneficiaries, but also consumers enrolled in commercial plans and other coverage options such as insurer-managed Medicaid plans.

The CMS said it would only launch the model in markets where there was significant private payer interest. Some plans reacted with concern over how the model was structured.

CPC+ has two tracks. Under track one, providers receive a monthly fee for specific services in addition to the fee-for-service Medicare payments.

But in track two, practices will receive an upfront monthly care-management fee and reduced fee-for-service payments. This hybrid model is designed to let practices provide care outside of the traditional face-to-face encounter, the agency said.

Companies offering preferred provider organization (PPO) and high-deductible plans told the CMS they could not participate in the program because of legal restrictions in many states. Some states have laws that prohibit non-HMO plans from offering capitated or risk-based payments to physicians.

CMS saw interest in fewer markets than expected. The model was supposed to launch in up to 20 regions. Still, the CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.

“We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system,” CMS' Chief Medical Officer, Dr. Patrick Conway said in a statement.

The agency is soliciting applications from eligible practices within the 14 regions from August 1-September 15, 2016. The model kicks off January 2017.