RI practices invited to take part in CMS medical home model program

  • 09 Aug 2016

PROVIDENCE – Rhode Island’s primary care practices are invited to participate in a national primary care medical home model, effective January 2017, according to the Centers for Medicare & Medicaid Services. The Comprehensive Primary Care Plus, a five-year medical home model, enables primary care practices to choose how to deliver the best outcomes and to receive payment for achieving results and improving care. Through CPC+, practices of diverse sizes, structures and ownerships are eligible to seek qualification in CMS’ Quality Payment Program’s Advanced Alternative Payment Models’ incentive payments. Primary care practices may apply to participate in CPC+ between Aug. 1 and Sept. 15.

On Aug. 2, the day CMS issued its CPC+ news release, R.I. Department of Health Director Dr. Nicole Alexander-Scott told Providence Business News that she was still learning the intricacies of CPC+. “It definitely shows that Rhode Island has an opportunity to be a leader in advancing accountable care and being able to provide coordinated care that’s going to address some of physical health and behavioral health needs that exist,” she said. “We’re looking forward to working with payers and practices; we’re excited to take advantage of this opportunity.”

CPC+, a public-private partnership in 14 regions (Rhode Island is the only New England entity), works with Medicare, Medicaid and private insurers to support primary care practices. Through CPC+, the health care system will move from the traditional fee-for-service model to a model supporting physicians who deliver the care that best fulfills patients’ needs and improves health outcomes, said CMS. The CPC+ website identifies Blue Cross & Blue Shield of Rhode Island, Tufts Health Plan and UnitedHealthcare of New England as the private insurers participating in Rhode Island.

“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent and rural practices, Dr. Patrick Conway, CMS deputy administrator and chief medical officer, said in the CMS statement. “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most – serving their patients’ needs when and how they choose.”

CPC+’s goal is to improve the quality of health care patients receive, improve patients’ health and spend health care dollars more efficiently, according to CPC+’s website. Participating practices are expected to make changes in delivering health care, with a focus on access and continuity of care, care management, comprehensive and coordinated care, patient and provider engagement and planned care and population health. Medical practices may participate in either of two CPC+ tracks. Track I practices will receive a monthly fee, as well as routine Medicare fee-for-service reimbursements. Track 2 participants will receive the monthly fee, along with a mixture of a reduced Medicare fee-for-service payment and comprehensive upfront payments, to allow practices, which will be required to deliver comprehensive services to those with behavioral and physical health issues, more flexibility in delivering care.

For more information, click HERE or email CPCplus@cms.hhs.gov.