Understand the CPC+ Initiative

Understand the CPC+ Initiative

April 2016 marked another landmark in our ever changing healthcare environment. To advance the nation’s shift to a value-based payment methodology, CMS announced the launch of the Comprehensive Primary Care Plus (CPC+) initiative. The objective of this new program is to allow physicians to spend more time with patients and better coordinate care outside of the primary care office to achieve better outcomes. A focus will be put on patients with serious or chronic conditions.

What is CPC+?

The CPC+ is a five year program which will begin January 2017 and will include up to 5,000 practices and 20,000 physicians in 14 regions. The program consists of five components:

  1. Access and Continuity
  2. Care Management
  3. Patient and caregiver Engagement
  4. Planned care and Population Health
  5. Comprehensiveness and Coordination

Physicians participating in this new program will be paid incentive payments for specific quality and utilization metrics. These payments will either be kept by the physicians or will have to be repaid depending on performance in the metrics. The new model also focuses on ensuring the availability of electronic health information.
On August 1st, CMS announced it would partner with the following 14 regions:

  • Arkansas: Statewide
  • Colorado: Statewide
  • Hawaii: Statewide
  • Kansas and Missouri: Greater Kansas City Region
  • Michigan: Statewide
  • Montana: Statewide
  • New Jersey: Statewide
  • New York: North Hudson-Capital Region
  • Ohio: Statewide and Northern Kentucky: Ohio and Northern Kentucky Region
  • Oklahoma: Statewide
  • Oregon: Statewide
  • Pennsylvania: Greater Philadelphia Region
  • Rhode Island: Statewide
  • Tennessee: Statewide

CMS began soliciting applications from practices within the 14 regions beginning August 1, 2016.  The application submission deadline is September 15, 2016. Practices will be eligible to apply to CPC+ only if they are located in one of the 14 selected CPC+ regions. This ensures that they are provided adequate support from multiple payers in their area and improve the success of the new delivery system.

Two More Tracks

Next month we will take a look at the two tracks that are available in this new initiative. Is your region one of the 14 that were chosen for this new program? If so, how do you think it will affect the coding and other areas within the business of healthcare?

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Colleen Gianatasio

About Has 9 Posts

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O, has over 20 years' of experience in the health insurance field, including customer service, claims, quality, and coding. As director of ambulatory CDQI at Mount Sinai Health Partners, her primary responsibilities are provider engagement and CDI for accurate coding and reimbursement. Gianatasio specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation, and auditing classes. She serves as president-elect of the AAPC National Advisory Board.

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