Report card for CPC+

In April 2019, the Centers for Medicare & Medicaid Services issued a report covering the first year of the Comprehensive Primary Care Plus (CPC+) program, which CMS calls the largest and most ambitious primary care payment and delivery reform ever tested in the United States.

In 2017, CMS partnered with 63 public and private payers and 2,905 primary care practices in 14 regions across the United States. The practices included 13,209 primary care practitioners, which together served approximately 15 million patients. Participating practices were diverse, ranging in size from one to 80 primary care practitioners. CMS expanded the program to an additional four regions in 2018, partnering with a total of 79 public and private payers.

CMS and other payers agreed to provide CPC+ practices with enhanced and alternative payments, data feedback, and learning activities to support primary care transformation. Health information technology (health IT) vendors also partnered with CPC+ practices to help them use health IT to improve primary care.

The goal of CPC+ is to increase access to – and improve the quality and efficiency of – primary care, ultimately resulting in better health outcomes at lower cost. CPC+ also aims to enhance primary care practitioners’ experience. To meet this goal, CMS requires CPC+ practices to transform across five Comprehensive Primary Care Functions:

  • Access and continuity
  • Care management
  • Comprehensiveness and coordination
  • Patient and caregiver engagement
  • Planned care and population health

In 2017, the median care management fees practices received for participating in CPC+ from CMS and other payers – over and above what they already receive for providing care – exceeded $88,000 per Track 1 practice, which translates to $32,000 per practitioner on average; and $195,000 per Track 2 practice, which translates to $53,000 per practitioner on average. (Compared to Track 1, practices in Track 2 are required to make more advanced care delivery changes to improve the care of complex patients and, to support that work, they receive more financial support and a greater shift from fee-for-service toward population-based payment.)

CMS paid higher care management fees per patient than other payers, in part to compensate for the higher needs of Medicare fee-for-service beneficiaries.

Some CPC+ practices, known as “deep-dive practices” were selected for intensive qualitative study. The deep-dive practices reported that enhanced payments were the most critical support for improving primary care in 2017. Most deep-dive practices reported that they used CPC+ care management fees to improve their care delivery, most commonly by hiring new staff such as care managers. However, on the 2018 CPC+ Practice Survey, only 41 percent of Track 1 practices and 51 percent of Track 2 practices indicated that CPC+ funding from Medicare FFS was adequate or more than adequate for them to complete the work required by CPC+.

Practices were more concerned about payment levels from non-Medicare FFS payers. Only one-third of practices in each track reported that payments from these payers were adequate. Deep-dive practices noted that non-Medicare FFS payers often did not provide additional support unique to CPC+ and that their care management fees were generally lower than practices anticipated.

To view the report, “Independent Evaluation of Comprehensive Primary Care Plus (CPC+): First Annual Report,” go to https://www.mathematica-mpr.com/our-publications-and-findings/publications/independent-evaluation-of-comprehensive-primary-care-plus-cpc-first-annual-report