CMS.gov: Comprehensive Primary Care Plus (CPC+)
CPC+ Behavioral Health
Comprehensive Primary Care Plus (CPC+)
- A national primary care medical home model
- Includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options.
- A unique public-private partnership, in which practices are supported by 56 aligned payers in 18 regions (PDF).
CPC+ seeks to improve quality, access, and efficiency of primary care. 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.
Payment elements
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.
- Performance-Based Incentive Payment: CPC+ prospectively pays 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.
Information for Practices
Information for Health IT Vendors
Payors
CPC+ Payer List (PDF)
AllCare Health, Inc.
CareOregon
Eastern Oregon Coordinated Care Organization (EOCCO)
InterCommunity Health Plans (IHN-CCO)
Medicaid
Moda Health Plan
PacificSource
PrimaryHealth of Josephine County
Providence Health Plan (PHP);
Providence Health Assurance (PHA)
Trillium Community Health Plan
UnitedHealthcare
Advanced Health
Willamette Valley Community Health
Yamhill Community Care Organization
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