The Comprehensive Primary Care Plus (CPC+) model is a public and private partnership designed to improve quality of care, reduce unnecessary patient services, and provide practices with additional financial flexibility and resources. With 61 payers across 18 regions serving 2.7 million patients, the model also coordinates actionable data feedback to improve provider decision making. The new model, initiated in 2016, is similar to the original CPCI model, but it promotes a focus on population health management and care coordination while providing financial improvements. CPC+ is a significant milestone in the progression to value-based, whole person care.
The Centers for Medicare and Medicaid Services designed CPC+ as a patient-centered model that supports the transition to value-based payment models. The model provides two financial tracks, each with a specific focus on five areas:
- Access and continuity
- Care management
- Comprehensiveness and coordination
- Patient and caregiver engagement
- Planned care and population health
Both tracks receive monthly care management fees as well as fee-for-service payments. Track two participants receive reduced fee-for-service payments and instead make up the difference with value-based care incentives. Both tracks are pre-paid but providers will be allowed to keep—or asked to return—payments based on the quality of performance. This model places those payments at risk, thus encouraging providers to meet targets and performance standards.
With a key focus on quality of care versus quantity, CPC+ encourages practitioners to better serve patient needs both in and out of the office as well as improve coordination with specialists. For example, one study conducted by CMS determined that 96 percent of participating providers performed care coordination tasks and 76 percent initiated new programs to improve risk determination efforts. Perhaps more encouraging, 85 percent of participants in track two provided screenings around social needs and social determinants of health with an additional 65 percent providing care in non-traditional care facilities. These improvements demonstrate the progress made in the push to whole person care, population health, and a coordination of efforts coinciding with social data gathered across the model.
In addition to driving quality improvements in care, CPC+ mandates the use of certified health IT. These systems improve the automation and interoperability of healthcare systems and help improve overall population health, reduce costs, improve efficiencies, and assist in overall care coordination. As practices develop processes to meet performance targets and standards, health IT will play a critical role in developing interoperability and coordination systems.
CPC+ is a significant improvement over the original CPCI model. By emphasizing whole person care and incentivizing value-based care, the model promises gains in population health. While it remains to be seen if the model will provide cost reductions in primary care, over time the model may help contain those costs, providing additional benefits for patients.