The FMA Health CPCP Payment Calculator & Guide

The Comprehensive Primary Care Payment (CPCP) model was developed from a research study by Family Medicine for America’s Health to examine the efficacy, challenges, and successes of value-based primary care payment models currently in use in the U.S. The resulting recommendations provide a framework and justification for critical components of a CPCP model. This methodology applies these recommendations by calculating a payment rate that is driven by current fee-for-service payment history and then applying 4 modifiers. These modifiers adjust the base rate to account for patient risk and social determinants of health for the population in question. They also provide further adjustments for quality, efficiency, and infrastructure for the primary care provider in question. The model is built on the assumption that to achieve the goals of the Triple Aim, primary care practices must transform to a medical home team-based model, and that there must be a commensurate reimbursement model to support the practices.

The purpose of this model is to assist provider groups and payers in the evaluation of comprehensive payment models for primary care and to provide a framework for implementing this type of model. Entities using this model are encouraged to model many different scenarios in order to understand the drivers of the model outputs given the particulars of their business and their goals. Successful entities will use this model to drive conversations with their partners about how a mutually beneficial comprehensive payment model would be structured and fine-tuned.