CMS launches transition to value-based care models

As the healthcare industry proceeds to evolve, it has begun to move way from traditional models of reimbursement and instead, turn toward value-based care initiatives. On Monday Apr. 11, the Centers for Medicare & Medicaid Services unveiled the Comprehensive Primary Care Plus model. 

New initiatives
According to the CMS press release, the CPC+ model is the largest-ever multi-payer initiative, created with the intention to improve the quality and cost of patient care across the U.S. Expanding on the Comprehensive Primary Care initiative launched in late 2012, the new five-year model will accommodate close to 5,000 practices across 20 regions. Including more than 20,000 clinicians and doctors, the model would impact their 25 million patients.

"Strengthening primary care is critical to an effective health care system," said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. "By supporting primary care doctors and clinicians to spend time with patients, serve patients' needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we're striving towards."

The overall goal of the model is to give doctors more freedom when it comes to caring for their patients. They will now have the sovereignty to provide the care that they believe will bring the most optimal outcomes for their patients. They will then be paid for improving care and achieving positive results.

Moving away from fee-for-service models, the CPC+ initiative will not only allow physicians more freedom but also help primary care practices in a number of ways, according to the CMS. It will provide patients with 24-hour access to healthcare and information online, further engage patients and families in the care process, support patients with serious and chronic conditions to reach their health goals, deliver preventative care and better coordinate care by working with hospitals, specialists and other clinicians.

The transition
The CPC+ model is intended to deliver a higher level of care to patients under the initiative, which will assist primary care practices with the transition to the new models, according to EHR Intelligence. Practices will slowly be eased into the risk-based payments to mitigate the period of change. There will be two financial tracks for primary care practices to utilize, both of which will use value-based reimbursement models to meet the new criteria. However, track two will be more dependent on a value-based payment model.

Primary care practices on track one will be on the Medicare Physician Fee Schedule under which they'll receive monthly care management fees and fee-for-service payments. While track two practices will also get the monthly management fees, they will also receive lowered fee-for-service payments on top of the value-based care payments.

Regardless of the track they are on, primary care practices will get up-front incentive payments from the CMS to encourage outcomes-based care. Depending on the practices' performances on quality measurements, they'll either pay them back or keep the payments, reported EHR Intelligence.

Incorporating health IT
Another focus of the CPC+ model will be strong, active use of health IT, reported Becker's Hospital CFO. For those on financial track two, a letter of support from their health IT vendor will be required. The letter must state that the vendor is committed to supporting and reaching the value-based goals of the new initiative.

The new value-based model is set to be implemented in January 2017. Proposals from prospective healthcare payers hoping to partner in CPC+ will be accepted by the CMS from April 15 through June 1, 2016.