Physician Practice

CMS announces CPC+ eligible regions

Physician Practice Insider, August 9, 2016

Fourteen payer regions eligible to participate in the Comprehensive Primary Care Plus (CPC+) model, CMS announced August 1. Nine of the selected regions are statewide and three are based on metropolitan regions. One eligible region combines the state of Ohio and northern Kentucky. The other 13 statewide and metropolitan regions are:

  • Arkansas
  • Colorado
  • Hawaii
  • Greater Kansas City region (Kansas and Missouri)
  • Michigan
  • Montana
  • New Jersey
  • North Hudson-Capital region (New York)
  • Oklahoma
  • Oregon
  • Greater Philadelphia region (Pennsylvania)
  • Rhode Island
  • Tennessee

The CPC+ model relies on the participation of commercial insurers and state Medicaid agencies to offer practices the financial support needed to make changes required by the model. Regions were selected to ensure that participating practices would have adequate support. Participating commercial insurers include Aetna, UnitedHealthcare, and Anthem.

CPC+ is built on the Comprehensive Primary Care (CPC) model and is designed to help physician practices meet CMS’ goal of transitioning from fee-for-service to flexible payment models that allow physicians to deliver patient-centered care while reducing the overall cost of care. CPC+ is aimed specifically at primary care practices.

The model qualifies as an advanced alternative payment model (APM). Practices participating in an advanced APM are exempt from the Merit-Based Incentive Payment System (MIPS) reporting requirements and payment adjustments from 2019-2024. They will also be eligible for a 5% APM incentive payment, according to a CPC+ FAQ released August 1.

CPC+ offers two tracks with different payment methodologies. To participate, practices must have multi-payer support, use certified EHRs, and meet other conditions for participation in the model.

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