Comprehensive Primary Care Plus

Comprehensive Primary Care Plus (CPC+) was a national advanced primary care medical home model that aimed to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ included two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.).

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There were 2,610 primary care practices participating in Comprehensive Primary Care Plus (CPC+) in 18 regions: Arkansas, Colorado, Hawaii, Greater Kansas City Region of Kansas and Missouri, Louisiana, Michigan, Montana, Nebraska, North Dakota, Greater Buffalo Region of New York, North Hudson-Capital Region of New York, New Jersey, Ohio and Northern Kentucky Region, Oklahoma, Oregon, Greater Philadelphia Region of Pennsylvania, Rhode Island, and Tennessee. 
 
 
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Background

CPC+ was a unique public-private partnership, in which practices were supported by 52 aligned payers in 18 regions (PDF). This partnership gave practices additional financial resources and flexibility to make investments, improve quality of care, and reduce the number of unnecessary services their patients received.

CPC+ provided practices with a robust learning system, as well as actionable data feedback to guide their decision making. The care delivery redesign ensured practices had the infrastructure to deliver better care, resulting in a healthier patient population.

Model Details

CPC+ sought to improve quality, access, and efficiency of primary care. Practices in both tracks made changes in the way they delivered care, centered on key Comprehensive Primary Care Functions: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health.

To support the delivery of comprehensive primary care, CPC+ included three payment elements:

  1. Care Management Fee (CMF): Both tracks provided a non-visit-based CMF paid per-beneficiary-per month (PBPM). The Medicare FFS CMFs were paid on a quarterly basis. The amount was risk-adjusted for each practice to account for the intensity of care management services required for the practice’s specific population.
  2. Performance-Based Incentive Payment: CPC+ prospectively paid and retrospectively reconciled a performance-based incentive based on how well a practice performed on patient experience measures, clinical quality measures, and utilization measures that drove total cost of care.
  3. Payment under the Medicare Physician Fee Schedule: Track 1 billed and received payment from Medicare FFS as usual. Track 2 practices also continued to bill as usual, but the FFS payment was reduced to account for CMS shifting a portion of Medicare FFS payments into Comprehensive Primary Care Payments (CPCP), which was paid in a lump sum on a quarterly basis absent a claim. Track 2 practices were expected to increase the comprehensiveness of care delivered, and thus, the CPCP amounts would have been larger than the FFS payment amounts they were intended to replace.

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Last updated on:
05/19/2022