CMS Initiative Aims to Shake Up Primary Care

The CMS is launching what it says is the largest everinitiative to transform the way primary care in America is delivered and reimbursed for more than 25 million patients.

The Comprehensive Primary Care Plus (CPC+) model is a five-year voluntary program that will be implemented in up to 20 regions and can accommodate up to 5,000 practices. Payments under the model will encourage doctors to focus on health outcomes rather than the volume of visits or tests and will give doctors new flexibility, the Centers for Medicare & Medicaid Services said April 11.

Under the CPC+ model, Medicare will work with commercial and state health insurance plans to provide the necessary financial support for practices to make significant changes in their care delivery, the agency said.

The idea of the program is to move beyond simple fee-for-service (FFS) reimbursements in primary care. Unlike in FFS, participating providers will receive monthly care management fees based on beneficiary risk tiers. Doctors will also receive bonus payments based on their performance on patient experience, clinical quality, and utilization measures.