Comprehensive Primary Care Plus (CPC+) - IBM...Comprehensive Primary Care Plus (CPC+) A CMS Center...
Transcript of Comprehensive Primary Care Plus (CPC+) - IBM...Comprehensive Primary Care Plus (CPC+) A CMS Center...
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Comprehensive Primary Care Plus (CPC+)
A CMS Center for Medicare & Medicaid
Innovation (CMMI) care delivery and
payment redesign model
Donna M. Daniel, PhD
Senior Program Director
Continuum of Care
July 28, 2016
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Housekeeping
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Polling Question
Q: Are you or your organization planning to submit an application for
the Comprehensive Primary Care Plus (CPC+)?
Responses:
Definitely
Possibly
Probably Not
I Don’t Know
Not Applicable (e.g., not a member of a practice)
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MACRA (QPP)Providers Have Choices Regarding Medicare Payment Under MACRA
MIPSMerit-Based Incentive Payment System
System• APMs (not advanced)
• Not First Year Medicare Part B participation
• >$10K charges to Medicare per year
• >100 empaneled Medicare pts per year
ADVANCED Alternative Payment Models
•Medicare Shared Savings Program, Tracks 2&3 (MSSP)
•Next Generation ACO Model
•Comprehensive ESRD Care (CEC)
•Comprehensive Primary Care Plus (CPC+)
•Oncology Care Model (OCM)
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On April 11, 2016, CMS announced the
latest and largest investment in Advanced Primary Care:
Comprehensive Primary Care Plus (CPC+)
50% of all Medicare fee-for-service payments to be made via alternative
payment methods by 2018
Improved care coordination and management for Medicare beneficiaries
Predicted to save up to $2 Billion in healthcare
expenditures by 2022 (Diamond, 2016).
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New Advanced Primary Care Medical Home Model
5 year initiative
Regionally-based
Multi-payer
Comprehensive Primary Care Delivery
What is Comprehensive Primary Care Plus
(CPC+)?
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CPC+ Timeline to Launch
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Differences between CPC & CPC+
Comparison of the Design Features of CPC and CPC+ Tracks 1 and 2 (2016). Medicare’s Vision for Advanced Primary Care: New Directions for Care Delivery and Payment. JAMA.
Published online April 11, 2016. doi:10.1001/jama.2016.4472
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Goals of CPC+
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
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Framework for Payer Partnership
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
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Practices Apply to Participate in 1 of 2 Tracks
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
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CPC+ Practice Eligibility Criteria
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
CMS will accept practice applications from
July 15 through September 1 August 1 through September 15, 2016.
Practices should apply for the Track they believe they are eligible.*
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Practices will Engage Health IT Vendors
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
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CPC+ Functions Guide Transformation towards
Comprehensive Primary Care
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
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Comprehensive Primary Care Functions -
Enhanced
CMS Center for Medicare & Medicaid Innovation (2016b).CPC+ Advancing the delivery of and payment for primary care. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-modeloverviewslides.pdf.
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Comprehensive Primary Care Functions -
Enhanced
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• Office or other Outpatient visit for Evaluation & Management of a new patient:
99201-99205
• Office or other Outpatient visit for Evaluation & Management of an established patient
99211-99215
• Welcome to Medicare and Annual Wellness Visits:
G0402, G0438, G0439
• Complex Chronic Care Coordination services:
99487-99489
• Transitional care management services:
99495-99496
• Home visit for the Evaluation & Management of a New Patient:
99341-99350
• Chronic Care Management services:
99490
Who are Your Attributed Patients?
CMS Center for Medicare & Medicaid Innovation (2016b). Comprehensive Primary Care Plus (CPC+) Request for Applications. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-rfa.pdf.
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Three Payment Innovations Support Practice
Transformation
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Care Management Fees Determined by Risk Tier
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Two Performance-Based Incentive Payment
Opportunities
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Track 2 Payment Offers More Flexibility in Care
Delivery
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Example of CPC+ Total Payments
1000 Medicare Covered Lives, per Provider
ProviderProcedure Billing makes up 50% of Total Billing
Average E&M Billing Yr.4 in CPCI = $15.00 PBPM
Per Provider Per Year*
E&M BillingProcedure
Billing
MACRA
5%**
Care
Management Fee
(CMF)
Performance-
based
Incentive
Payment
TOTAL
Potential $$Upfront $$
FFS $180,000 $180,000 $0 $0 $0$360,000
(average)$0
CPC+ Track 1 $180,000 $180,000 $18,000$180,000
(avg= $15 pbpm)
$30,000
($2.50 pbpm)
$588,000
(average)
$180,000
(CMF)
CPC+ Track 2
(@65%/35%)~$198,000 $180,000 $18,900***
$336,000
(avg=$28 pbpm)
$48,000
($4.00 pbpm)
$780,900
(average)
$464,700
(65% CPCP
+ CMF)
Let’s assume:
23CMS Center for Medicare & Medicaid Innovation (2016b). Comprehensive Primary Care Plus (CPC+) Request for Applications. Baltimore, MD: CMS. Retrieved from https://innovation.cms.gov/Files/x/cpcplus-rfa.pdf.
*Subject to change based on release of technical methodology anticipated to be released late 2016.
**Subject to change based on the final rule.
***It is unclear if the 5% bonus from MACRA will include the 10% increase in historical E&M billing.
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Proposed CPC+ Quality Measure Set
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CMS knows that practices are
the primary drivers of change
CMS will provide online learning tools
so ensure:
Practice ownership and
management of CPC+
implementation
Practices are able to make
Assessments and give feedback
Support from CMS staff
Alignment with national and regional
health care reform efforts
CPC+ Learning System Strategy
CPC
Connect
Learning
communitiesNational and Regional
CPC Report
Tool
Data
Sharing
CMS Center for Medicare & Medicaid Innovation (2016b). Comprehensive Primary Care Plus (CPC+) Request for Applications. Baltimore, MD: CMS. Retrieved from
https://innovation.cms.gov/Files/x/cpcplus-rfa.pdf.
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Practices Rely upon Frequent Data Feedback from
CMS, Payer Partners and IBM Watson Health
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How IBM Watson Health Solutions support CPC+
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https://innovation.cms.gov/initiatives/ Comprehensive-Primary-Care-Plus
or email:
or call the CPC+ Help Desk:1-844.442.26728:30a.m. – 7:30p.m. ET
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Questions?
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CMS Center for Medicare & Medicaid Innovation (2016a). Comprehensive Primary Care Plus
(CPC+) Fact Sheet. Baltimore, MD: CMS Retrieved from
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-
items/2016-04-11.html.
CMS Center for Medicare & Medicaid Innovation (2016b). Comprehensive Primary Care Plus
(CPC+) Request for Applications. Baltimore, MD: CMS. Retrieved from
https://innovation.cms.gov/Files/x/cpcplus-rfa.pdf.
CMS Center for Medicare & Medicaid Innovation. (2016c). CPC+ Frequently Asked Questions.
Baltimore, MD: CMS Retrieved from https://innovation.cms.gov/Files/x/cpcplus-faqs.pdf.
Diamond, D. (2016). How to think about medicare’s new primary care plan. Politico. Retrieved
from http://www.politico.com/tipsheets/politico-pulse/2016/04/how-to-think-about-medicares-
new-primary-care-plan-213715.
Dickson, V. (2016). New CMS primary-care payment model would affect 20K doctors. Modern
Healthcare. Retrieved from
http://www.modernhealthcare.com/article/20160411/NEWS/160419999?template=print
Heath, S. (2016). CMS unveils value-based patient-centered primary care model. Health IT
Analytics. Retrieved from HealthITAnalytics.com website: http://healthitanalytics.com/news/cms-
unveils-value-based-patient-centered-primary-care-model
Sessums, L. L., McHugh, S. J., & Rajkumar, R. (2016). Medicare's vision for advanced primary
care; New directions for care delivery and payment. Journal of American Medical Association,
E1-E2. doi:10.1001/jama.2016.4472
References
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