CMS Comprehensive Primary Care Plus (CPC+)

Practices will enter one of two program tracks. The track dictates the care delivery capabilities practices will develop and the payment structure they will receive.

CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States. The two tracks, which are comprehensive care and financial support will dictate the care delivery capabilities practices will develop and the payment structures that they receive. Practices in both tracks will make changes in the way they deliver care, centered on key Comprehensive Primary Care Functions: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health.

To support the delivery of comprehensive primary care, CPC+ includes three payment elements:

1. Care Management Fee (CMF): Both tracks provide a non-visit-based CMF paid per-beneficiary-per month (PBPM). The Medicare FFS CMFs are paid on a quarterly basis. The amount is risk-adjusted for each practice to account for the intensity of care management services required for the practice’s specific population. For track 1 the payments average out to $15. Track 2 payments are an average of $28 including $100 to support patients with complex needs.
2. Performance-Based Incentive Payment: CPC+ pays prospectively on an annual basis and retrospectively reconciles a performance-based incentive based on how well a practice performs on patient experience measures, clinical quality measures, and utilization measures that drive total cost of care.
3. Payment under the Medicare Physician Fee Schedule: Track 1 continues to bill and receive payment from Medicare FFS as usual. Track 2 practices also continue to bill as usual, but the FFS payment will be reduced to account for CMS shifting a portion of Medicare FFS payments into Comprehensive Primary Care Payments (CPCP), which will be paid in a lump sum on a quarterly basis absent a claim. Track 2 practices are expected to increase the comprehensiveness of care delivered, and thus, the CPCP amounts will be larger than the FFS payment amounts they are intended to replace.