CMS Selects Markets for Primary Care Payment Initiative
- By BSTQ Staff
In August, the Centers for Medicare and Medicaid Services announced 10 states in four regions in which it will launch its primary care quality improvement initiative: Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee. The selections for the Comprehensive Primary Care Plus (CPC+) initiative were based on density and interest shown by practices and payers. In addition, 57 not-yet-named payers will participate in Kansas City, the North Hudson Valley in New York, Philadelphia and Northern Kentucky.
Under CPC+, CMS and other insurers will pay physicians a monthly fee for patient primary care visits under two tracks. In track one, providers will receive a monthly fee for specific services in addition to the fee-for-service Medicare payments. In track two, practices will receive an upfront monthly care-management fee and reduced fee-for-service payments. The latter is designed to let practices provide care outside of the traditional face-to-face encounter. The goal of CPC+ is to improve health outcomes and lower costs not only for Medicare beneficiaries, but also consumers enrolled in commercial plans and other coverage options such as insurer-managed Medicaid plans.
While CPC+ was originally expected to launch in up to 20 regions, CMS received interest from fewer markets than expected. However, CMS does expect that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries will participate.
