CPC+ Round 2 taking applications from Louisiana, Nebraska, North Dakota, and Buffalo NY practices

The second round of regions for participation in the Comprehensive Primary Care Plus (CPC+) model, an Advanced Alternative Payment Model (Advanced APM) has been announced by CMS, which is seeking eligible practices in three statewide regions—Louisiana, Nebraska, and North Dakota—and in the Greater Buffalo Region (Erie and Niagara Counties), New York. CPC+ Round 2 will accept applications beginning May 18 through July 13, 2017; accepted practices will be part of an innovative payment structure that rewards value and quality for primary care practices that improve quality, access, and efficiency. The four regions were chosen based on payer alignment and market density.

CPC+ Round 2 is smaller than Round 1, which included 14 regions (see More clinicians able to join Next Generation ACOs, CPC+ for 2018, December 16, 2016), and chosen practices will participate from 2018 through 2022. Practices located in Round 1 regions are not eligible to participate in Round 2, even if they applied for Round 1 and were not accepted or did not apply for Round 1. As part of the announcement for Round 2, CMS also provisionally selected five payer partners to provide additional support in certain Round 1 regions.

CPC+ was developed by the CMS Innovation Center, which was established by section 3021 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). As an Advanced APM, the program is part of the Quality Payment Program (QPP), which is designed to reform Medicare payments to physicians as part of CMS’ implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10).

More clinicians able to join Next Generation ACOs, CPC+ for 2018

For the 2018 performance period of the Quality Payment Program (QPP), a program designed to reform Medicare payments to physicians to improve the quality of care provided, physicians will have additional opportunities to join two Advanced Alternative Payment Models (Advanced APMs). The Next Generation Accountable Care Organization (ACO) model and the Comprehensive Primary Care Plus (CPC+) model will accept new applications for participation early in 2017. Once new applicants are accepted, CMS expects that 25 percent of QPP participants will be part of Advanced APMs for performance year 2018 and eligible to receive incentive payments from Medicare.

The QPP is part of CMS’ implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), which builds on measures created by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). It consists of two tracks for eligible professional participation: Advanced APMs and the Merit-based Incentive Payment System (MIPS). To participate as an Advanced APM, the eligible professional must be part of certain payment models, including the Next Generation ACO and CPC+ models, both of which were created by the CMS Innovation Center, which was established under section 3021 of the ACA.

The announcement that both models will open for applications in early 2017 follows promises made by CMS two months ago (see New alternative payment models announced by CMS, October 26, 2016). As part of its announcement, CMS released a Fact Sheet on the CPC+ Payer and Practice Solicitation. The American Medical Association (AMA) commended the expansion, saying that, because of Advanced APMs, “physicians will have more time with patients and more flexible payments to support care coordination and improvements in access and quality.”

Primary care reform efforts showing progress

Four out of seven regions shared in savings with CMS and nearly 95 percent of all practices met quality of care requirements in the second year of CMS’ Comprehensive Primary Care (CPC) initiative. CPC is a multi-payer program launched by the Center for Medicare and Medicaid Innovation (CMMI) in October 2012 to advance primary care by paying clinicians to deliver accessible, comprehensive, and coordinated care in seven regions across the country. Throughout 2015, CPC generated $57.7 million in gross savings in Medicare Part A and Part B expenditures, which was equivalent to the $58 million paid in care management fees to the practices involved. More than half of the participating CPC practices will also receive a share of over $13 million in earn shared savings. According to CMS, the results reflect the work of 481 practices that served over 376,000 Medicare beneficiaries and more than 2.7 million patients overall in 2015.

Four of the seven regions participating in CPC – the states of Arkansas, Colorado, and Oregon, and the Greater Tulsa region in Oklahoma – realized net savings and will share in those savings with CMS; the savings generated in these four regions covered the net losses in the other three CPC regions. In addition to the Medicare savings, CPC practices had lower than expected hospital admission and readmission rates, as well as favorable performance on patient experience.

Gross savings nearly doubled from the first performance year in 2014; practices in four regions were eligible to receive shared savings, compared to one region in 2014. CMMI’s Comprehensive Primary Care Plus (CPC+) will begin on January 1, 2017, with 14 selected regions.

Quality measures

CMS included electronic clinical quality measures (eCQM) for the first time in Medicare shared savings determinations for CPC. CMS noted that these practices with eCQM also exceeded national benchmarks; the eCQM data are recorded in the electronic health record in the routine course of clinical care, enabling real time quality improvement efforts.

The majority of CPC practices that reported eCQM surpassed the median national performance for 10 out of 11 eCQMs in the measure set, with 97 percent of CPC practices successfully reporting nine eCQMs.

CPC initiative

CPC is the largest test of advanced primary care in U.S. history, exploring the potential of primary care clinicians redesigning practices to deliver better care to patients, as well as supporting physicians’ ability to innovate and deliver care to meet patients’ needs and preferences.