Colorado Comprehensive Primary Care Plus Initiative
Program Location:
CO
Number of Practices:
199
Payer Type:
Multi-Payer
Parent Program:
Payers:
Anthem
Blue Cross and Blue Shield
Colorado Choice Health Plans
Medicaid
Rocky Mountain Health Plans
UnitedHealthcare
Reported Outcomes
Description:
Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation over a five year period. CPC+ is a unique public-private partnership that gives practices additional financial resources and flexibility to make investments, improve quality of life, and reduce the number of unnecessary services their patients receive. Centers for Medicare & Medicaid Services (CMS) is partnering with 61 aligned payers in 18 regions. Colorado has adopted the statewide comprehensive health care model in 199 primary care practices.
Payment Model:
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:
- 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.
- 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.
- 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.
Data Source(s):
