On Monday, the Centers for Medicare & Medicaid Services (CMS) introduced a new model that could allow doctors to have more flexibility to decide how patients should receive primary care, leaving behind the traditional fee-for-service model in primary care.

This innovating initiative can accommodate up to 5,000 practices and would encompass over 20,000 providers and 25 million patients all over the country, says CMS.

CMS announced The Comprehensive Primary Care Plus (CPC+) program for Medicare beneficiaries. The program is a regionally-based, multipayer care delivery and alternative payment model (APM) that rewards value and quality through a payment structure to support comprehensive primary care.

On Monday, the CMS introduced a new model that could allow doctors to have more flexibility to decide how patients should receive primary care. Photo credit: Bloomberg / Business Insurance
On Monday, the CMS introduced a new model that could allow doctors to have more flexibility to decide how patients should receive primary care. Photo credit: Bloomberg / Business Insurance

CMS new model is an improvement from traditional fee-for-service model in primary care

Officials at the CMS said that this primary care initiative will allow physicians to care for Medicare patients the way they consider it appropriate. The model will include two tracks with improved care delivery requirements and payment options to access the diverse needs of primary care practices.

According to Managed Healthcare Executive Editorial Advisor, Don Hall, a former health plan CEO is principal, Delta Sigma LLC, in Littleton, Colo, in January 2017 will begin the five-year evaluation for the CPC+. Hall says that the two approaches will bring various pay-for-performance incentives.

“CMS will be contracting with health plans to recruit primary care practices and to administer the program,” he added.

In order to allow more flexibility to the practices in delivery care outside of the traditional face-to-face encounter, the model will employ two tracks: in Track 1, CMS will provide monthly care management fee to the practices, and fee-for-service payments under the Medicare physician fee schedule, says Medical Economics. In Track 2, instead of full fee-for-service payments, the practices will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services, as CMS describe it.

“This model is shaping the future of primary care in America.”, said Patrick Conway, MD, CMS chief medical officer, on a phone call with reporters.

This model was based on a previous model called Comprehensive Primary Care (CPC), launched in 2012. On April 15, 2016, CMS is soliciting payer proposals to partner in CPC+.

Source: Managed Healthcare Executive