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New CMS Primary Care Model To Give More Flexibility To Doctors

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The Centers for Medicare and Medicaid Services (CMS) announced on April 11 that it will launch a new model for comprehensive primary care that will give more flexibility to doctors.

The initiative is the largest effort to change and enhance the way primary care is being rendered and paid for in the United States.

The new model, called Comprehensive Primary Care Plus (CPC+), is created to give doctors the freedom to give the care management services their patients need to achieve the best outcomes and receive payments for achieving progress and boosting care.

"Strengthening primary care is critical to an effective health care system," says CMS's chief medical officer Dr. Patrick Conway.

He adds that by implementing a setup where doctors get to spend more time with patients, serve them even outside the clinic and promote coordinated care among specialists, the CMS can create a health care delivery system that results in healthier individuals and more innovative payment schemes.

Personalized Care

CPC+ will join two tracks, simply dubbed Track 1 and Track 2. Track 2 is the more novel approach as it will entail more complex medical and behavioral services including resources inventory and psychosocial needs assessment. This will then eliminate the very general health care delivery system of the one-size-fits-all and fee-for-service approach.

In Track 1, CMS will pay a monthly fee to medical providers on top of the fee-for-service payments.

In Track 2, there will also be a monthly care fee, but instead of the additional fee-for-service, doctors will receive reduced payments for every service. Clinicians will receive up-front primary care payments for the said services. This approach will promote more flexibility in how doctors give care outside of the conventional clinic visits.

Hopefully, this scheme will pave the way for more justifiable payments to health care providers to prevent past payment controversies including the 2013 issue where doctors and hospitals received $3.5 billion worth of payments within only five months.

Patient Benefits

Aside from giving flexibility to doctors, CPC+ also aims to improve patient experience and provide the benefits of primary care practices, which include assisting patients with advanced or chronic diseases to attain their health objectives, providing patients with a round-the-clock access to health information, giving preventive care, encouraging engagement among patients and families in their own care and promoting collaboration with hospitals and other doctors, including specialists for better care.

CPC+ will be practiced in up to 20 locations and entail about 5,000 practices, stretching the scope to more than 20,000 clinicians and their 25 million patients.

The CMS will accept proposals from payers who would like to participate in CPC+ from April 15 to June 15. The agency will also accept practice applications in the chosen locations from July 15 to Sept. 1.

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