Montana Comprehensive Primary Care Plus
Program Location:
MT
Number of Practices:
50
Payer Type:
Multi-Payer
Parent Program:
Payers:
Allegiance Benefit Plan Management Inc.
Blue Cross Blue Shield of Montana
Medicaid
PacificSource Health Plans
Reported Outcomes
Description:
Comprehensive Primary Care Plus (CPC+) is an advanced primary care medical home model that rewards value and quality through innovative payments that support comprehensive care. CPC+ is an initiative developed by CMS that transitions Medicare fee-for service to value based payments in collaboration with Medicaid and commercial payers in selected regions. Montana was selected to participate in round 1 of this 5-year test demonstration. Payers partners, and care providers have partnered with Medicaid in a project 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 patients receive.
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.
Improved Access:
Montana Medicaid has approximately 45,500 members attributed to CPC+ providers. The Medicaid expansion (HELP) and Healthy Montana Kids (HMK) populations are both included in CPC+ as well.
Data Source(s):
Last updated February 2019
