Five Things You Need to Know about CMS’ New CPC+ Initiative

April 14, 2016

Categories: Thought Leadership


This week, The Centers for Medicare & Medicaid Services (CMS) unveiled an initiative called Comprehensive Primary Care Plus, or CPC+. The aim of CPC+, which is slated to begin in January 2017, is to incentivize and support care providers in the shift toward value-based care. In the words of CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway,

“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.”

Here are our five takeaways:

1. This thing is huge: The initiative will encompass 20 regions, 5,000 practices, 20,000 providers and a total estimated patient base of more than 25 million Americans.

2. Health IT will play a big role: CPC+ will require a significant care delivery systems redesign in order to provide the proper infrastructure, including certified electronic health record (EHR) technology. The majority of this lift will fall on health IT vendors, and CMS has already announced it will offer Memorandums of Understanding to align goals.

3. Payment design will be hybrid: In order to ease into value-based care, the payment model will, for now, offer both fee-for-service and performance-based payments. In addition to the standard payments for procedures, practices will also receive an up-front incentive payment at the beginning of the year. If they meet certain quality and utilization standards, they get to keep the money. If not, it’s returned to CMS.

4. There will be two “tracks”: Understanding that the medical needs of Americans is diverse, CMS designed two separate tracks. Track 1 is a relatively simple approach to reimbursement that should accommodate average practices. Track 2, on the other hand, is designed to help support physicians that provide more comprehensive services for patients that have more complex requirements.

5. It is already receiving praise: So far, the initiative has been met with positive reactions from multiple industry players, including the Patient-Centered Primary Care Collaborative and Health IT Now.

From our vantage point, it appears as though CPC+ will help create a flexible reimbursement system that will aid in the transition to value-based payment models. As a leader in Health IT, CNSI is excited to see what kind of new innovations this program will bring about.

What do you think about CPC+? How do you think the industry will adapt to CPC+? Let us know by finding us on Twitter @CNSICorp.