Medicare Announces New Primary Care Payment Model

The Centers for Medicare & Medicaid Services (CMS) announced the Comprehensive Primary Care Plus initiative, a new payment model for primary care delivered in medical homes. The new plan, which will run from January 2017 through 2021, builds on the current Comprehensive Primary Care model that debuted in 2012 and expires at the end of this year.

The plan focuses on a greater reliance on monthly capitation payments and separating reimbursement from office-based visits, which CMS said will allow physicians to care for patients through secure email, telephone calls, video consults, and home visits.

CMS hopes to recruit up to 5,000 practices totaling 20,000 clinicians treating 25 million patients. CMS also plans to partner with private insurers, state Medicaid programs, and Medicare Advantage plans that agree to adopt the same payment, data-sharing, and quality metrics.

The new initiative offers primary-care practices two payment model tracks to choose from:

  • In track 1, practices receive a care-management fee ranging from $6 to $30 per beneficiary per month (PBPM), depending on medical needs ($15 on average).
  • In track 2, the care-management fee ranges from $9 to $100 PBPM ($28 on average), with the higher fee due to “more comprehensive services for patients with complex medical and behavioral needs,” according to a CMS press release.

Bonuses will also be provided to practices based on performance of quality of care and cost metrics ($2.50 PBPM in track 1 and $4 PBPM in track 2).

CMS will begin to formally solicit applications from practices interested in the program on July 15. Get more information.

Source: CMS press release, April 12, 2016.