Comprehensive Primary Care Plus (CPC+): 4 Positive Implications & 2 Practice Strategies

Written By: Leavitt Partners

As a former primary care clinic manager and COO of a medical group engaged in value-based contracts, I was excited to see CMS’ announcement on Comprehensive Primary Care Plus (CPC+). I welcome this shift in Medicare primary care payments away from the quagmire of Fee-For Service (FFS) and into the higher ground of partial capitation, where PCPs will be paid for value. It’s well established that FFS is not a good payment method for population management; CPC+ advances the possibilities by providing primary care groups with the flexibility and incentive for meaningful practice redesign. The potential positive effects on population health that CPC+ will bring about cannot be overstated.

In this blog I will share four general implications that will arise from CPC+ and two strategies primary care practices can employ to assure success. A Leavitt Partners whitepaper on CPC+, which was released today, provides detailed information on the program’s description and key implications for respective stakeholders including physicians, hospitals, payers, technology vendors, and pharmaceutical vendors.

Four Positive Implications Arising from CPC+

  1. Creation of Upfront Funding

Lack of upfront incentive funding has been a downside of some population health movements, but CPC+ puts prepaid incentives in place. Practices receive a prospectively paid (beginning of fiscal year) incentive payment based on defined targets and Per Beneficiary Per Month (PBPM) attributions, and then receive a retrospective adjustment based on performance for the prior fiscal year. I see prospective payments as a win for two reasons:

  • Allows the practice to make necessary financial investments;
  • Creates a more engaging and attractive strategy for practices than having just a retrospective payment.

CMS seems to be employing a behavioral economics strategy with prepaid incentives as the motivation for a practice is arguably higher to retain a payment than to be paid retrospectively.

  1. Increased Financial Value of Primary Care

CPC+ puts primary groups in the driver’s seat of managed care for their population, and primary care has an increased value in a value-based ecosystem where the focus is more on cost containment and preventive care.

From a financial value standpoint, primary care practices are attractive because of downstream referrals and shared savings/bonus payments.

  • On the former, health systems and hospitals have historically been interested in purchasing or partnering with primary care practices for the downstream revenue arising from referrals from primary care physicians to the health system’s specialty physicians and ancillary departments (lab, radiology, etc.).
  • On the latter, primary care practices are key partners in cost containment and population health, which beget shared savings and bonus payments. Primary care practices help a health system bend the population cost curve and effectively manage risk.

Financially summarizing, CPC+ is a partial capitation payment model which increases the role of primary care in population health, from which ACOs benefit in shared savings. Primary care bolsters a health system’s capabilities to effectively manage the progression of payment arrangements and risk.

Progression of Payment

  1. Increased Health IT Support

The path to value can only be achieved with robust health IT, and the implication is clear that CMS intends for practices to have the support of such vendors to maximize a practice’s capabilities as evidenced by the following stipulations:

  • Track 2 participants are required to have a letter of support from a health IT vendor that outlines the vendor’s commitment to support the practice in optimizing IT.
  • CMS will sign a Memorandum of Understanding (MOU) with each health IT vendor partnered with participant practices.
  • CMS invites health IT vendors to participate in relevant learning system activities with practices and payers to accelerate understanding of the technology needs of practices in delivering advanced primary care.
  • CMS will provide patient-level cost and utilization data, ideally aggregated by other payers, to help enable the practice’s decision making.

The implications of robust health IT support are significant – primary care practices will know more accurately how they’re doing and innovative groups will advance the forefront farther in delivering population health.

  1. Increased Virtual Encounters & Patient Access

Implications are strong that CPC+ will give rise to virtual encounters, helping physicians have more efficient means of patient communication while still being paid for their time.

  • On a patient level, CPC+ will give rise to email, phone, patient portal, and other virtual encounters not previously paid for by traditional Medicare fee schedules. These virtual communication mediums will hopefully free-up more of the doctor’s valuable/scarce time, and thereby help create more same-day appointment slots for the sickest and most needful patients.
  • On a system level, CPC+ will give rise to cloud-based EMRs and inter-organizational messaging and information sharing.

TWO STRATEGIES FOR PRIMARY CARE GROUPS TO ASSURE SUCCESS

  1. Practices Must Expand Care Teams and Programs

Primary care programs and care teams must expand and evolve to survive in a value ecosystem. Hampering innovation has been the fact that traditional Medicare fee schedules have only paid for Evaluation/Management (E/M) professional fees for MDs, NPs and PAs – as such the use of practitioners, paraprofessionals, and community health workers have sadly had very limited use in primary care.

CPC+ provides the needed payment structure to allow primary care practices to better innovate, to expand beyond a medical focus, and to initiate a more multi-disciplinary and social approach in the practice’s care team design.

Below is a draft framework I’ve created of a primary care team design for maximum value in value-based payments. My work in clinical and medical group management has largely been medical in focus, but my work at Leavitt Partners, where I’m able to interact with innovative health systems throughout the country, has helped me better understand the imperative value of integrating social resources into care teams for patients. In other words, I strongly believe primary care teams should be both medical + social in design.

  1. Increased Virtual Encounters & Patient Access

Implications are strong that CPC+ will give rise to virtual encounters, helping physicians have more efficient means of patient communication while still being paid for their time.

  • On a patient level, CPC+ will give rise to email, phone, patient portal, and other virtual encounters not previously paid for by traditional Medicare fee schedules. These virtual communication mediums will hopefully free-up more of the doctor’s valuable/scarce time, and thereby help create more same-day appointment slots for the sickest and most needful patients.
  • On a system level, CPC+ will give rise to cloud-based EMRs and inter-organizational messaging and information sharing.

TWO STRATEGIES FOR PRIMARY CARE GROUPS TO ASSURE SUCCESS

  1. Practices Must Expand Care Teams and Programs

Primary care programs and care teams must expand and evolve to survive in a value ecosystem. Hampering innovation has been the fact that traditional Medicare fee schedules have only paid for Evaluation/Management (E/M) professional fees for MDs, NPs and PAs – as such the use of practitioners, paraprofessionals, and community health workers have sadly had very limited use in primary care.

CPC+ provides the needed payment structure to allow primary care practices to better innovate, to expand beyond a medical focus, and to initiate a more multi-disciplinary and social approach in the practice’s care team design.

Below is a draft framework I’ve created of a primary care team design for maximum value in value-based payments. My work in clinical and medical group management has largely been medical in focus, but my work at Leavitt Partners, where I’m able to interact with innovative health systems throughout the country, has helped me better understand the imperative value of integrating social resources into care teams for patients. In other words, I strongly believe primary care teams should be both medical + social in design.

CPC 1 CPC 2
CPC+ puts program design decisions in the hands of those who know their patients and practice best: primary care physicians, rather than prescribing practice methods. Practices at different levels of transformation readiness will design methods to meet the needs of their patients and will have flexibility to deliver care.

  1. Practices Must Develop Internal Capabilities

The path to successfully engaging in risk-based contracts requires specific competencies, including those outlined below by the Accountable Care Learning Collaborative (ACLC). Each domain represents a discreet list of competencies for a risk-bearing organization, such as a primary care clinic engaging in CPC+.

These domains and respective competencies:

  • Will be published by the ACLC in two whitepapers in 2016;
  • Will be referenced by the National Academy of Medicine (NAM) in their forthcoming whitepaper; and
  • Are a great starting point for an organization to conduct an internal needs assessment, and to formulate objectives and strategies.

CPC 3

SUMMARY

CPC+ is a historic and transformative CMS strategy designed to free primary care practices from the historical constraints of fee-for service payments, and to put population health in the hands of primary care physicians.  Significant implications arise from the transition of primary care payments to value-based; the direct and indirect effects of CPC+ will be substantial.

Please see the Leavitt Partners whitepaper released today, which gives detailed information on the program and provides implications for respective stakeholders.