Comprehensive Primary Care Plus (CPC+) is a five-year, multi-payer model that builds on the original CPC initiative (CPC Classic) to improve primary care. Participating primary care practices receive additional payment outside of the fee-for-service, including population-based care management fees for better coordination of patient care and the opportunity for performance-based incentives.

Review the CPC+ Participating Provider Training deck for an overview of the program.

Frequently Asked Questions

CMS is testing various payment and service delivery models that aim to achieve better care for patients, smarter spending and healthier communities. CMS believes this can be achieved through payment reform and practice transformation as primary care practices build capabilities and processes to deliver better care. Payment redesign offers greater cash flow and flexibility for primary care practices to deliver high-quality, whole-person, patient-centered care while lowering the use of unnecessary services that drive total costs of care.
The major payers in Arkansas are QualChoice, Medicare, Medicaid, Arkansas Health and Wellness Solutions, HealthScope, Arkansas Superior Select and Arkansas Blue Cross Blue Shield. They are participating with the common goal to improve primary care to the patient.
Each payer determines their own financial support to practices, separately from that of normal fee-for-service.
Practices were selected through a competitive application process based on their:
  • use of health information technology
  • ability to demonstrate recognition of advanced primary care delivery by accreditation bodies
  • service to patients covered by participating payers
  • participation in practice transformation and improvement activities
  • diversity of geography, practice size and ownership structure
Practices that participate are expected to do so for the full five years. However, participation is voluntary and practices may withdraw without penalty.
Practices are required to notify CMS at least 90 calendar days before the planned day of withdrawal. Practices may also notify QualChoice directly of their intent to withdraw from the program.
CPC+ replaced the CPC Classic program. CPC+ offers providers two separate participation tracks. The track dictates the care delivery capabilities practices will develop and the payment structure they will receive.
There are two different participation tracks. Both tracks will receive Care Coordination fees during the year and Performance payments, if they meet Quality and Utilization metrics, after the completion of the first year.
  • Track One practices will continue to receive their regular fee-for-service payments for covered evaluation and management services.
  • Track Two practices will have a hybrid of fee-for-service and Comprehensive Primary Care Payment (CPCP) starting 1/1/2018. The hybrid value-based reimbursement will pay for covered evaluation and management services, but allows flexibility for the care to be delivered outside of a traditional office visit. Over the next 3 years, there will be a phased approach applied toward further reduction in fee-for-service and building value-based payments.
CPC Classic achieved gross savings and was nearly cost neutral, with positive quality results in its first year. These findings came earlier than expected in a model involving significant changes in the delivery of primary care. CPC+ looks to build on these results by offering two tracks with different payment options to better accommodate the diverse needs of primary care practices.
We will pay a performance-based incentive retrospectively if they meet annual performance thresholds.
The performance thresholds are broken into two distinct components, on which QualChoice will pay performance-based incentives retrospectively:
  • Performance on clinical quality/patient experience is based on clinical quality performance measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS) metrics.
  • Performance on utilization measures that drive the cost of care is based on claims-based measures commonly used to determine total cost of care and measurable at the practice level [e.g., inpatient admissions and emergency department visits that are available in the Healthcare Effectiveness Data and Information Set (HEDIS)].
A practice is paid depending on the CPC+ Track in which it participates. Participants in both tracks will receive Care Coordination fees and Performance payments in the first year.
  • Both Tracks Will be Paid:
    • Care Management Fee (CMF): a non-visit based, retrospective payment Per Member Per Month (PMPM). The amount is risk-adjusted for each practice to account for the intensity of care management services required for a practice's specific population. Practices will use this enhanced, non-visit-based compensation to augment staffing and training in support of population health management and care coordination.
    • Performance-Based Incentive Payment: QualChoice will pay retrospectively and annually a performance-based incentive payment on how well the practice performs on clinical quality measures and on utilization measures that drive total cost of care. The performance incentive will be based on both quality and utilization reports. Reporting data will be collected from claims and Category II CPT Codes (Non-billable Codes). Each practice should have minimum of 50 attributed members captured on a quarterly Attribution report to qualify for performance incentive payment.
  • Track One Will be Paid:
    • Fee-For-Service (FFS) from payers as usual throughout the five years.
  • Track Two Will be Paid:
    • Reduced Fee-For-Service (FFS) and comprehensive primary care payments, beginning January 1, 2018. After 3 years, further reductions may apply to the payments in a phased approach.
When a practice applies to CMS for CPC+ status and requests Track One or Track Two, part of the requirement is that the practice has Electronic Medical Records to help them with risk stratification.
QualChoice will make available on its provider portal a list of all attributed and assigned members. This list will be published monthly.
Extensive CMS resources are available to CPC+ providers, including live webinars and the CPC+ Connect internet tool. Visit the Centers for Medicare and Medicaid Services CPC+ webpage for more details.
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