CMS Launches Largest Multi-Payer Initiative — Exclusive Report

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Summary

CMS made breaking news this week that they will be launching the largest ever multi-payer initiative. Comprehensive Primary Care Plus (CPC+) model works with Medicare, Medicaid, and private payers to pay primary care doctors a bonus of $15 or $28 per patient per month for all medicare patients. When CPC+ goes live in 20 states it will affect the treatment of 25 million seniors. This program is estimated to be 10x larger than the original CPC. The new program will begin in January 2017.
 

Analysis

This new program provides an opportunity for providers to increase revenue and patients to receive a higher level of care. 
 
The program looks to bring patients many care services already offered by Oculus. This includes 24/7 access to a care team, a patient-centric care coordination platform, and support patients with chronic diseases.
 
We founded Oculus Health because health care today is broken. Doctors have become call centers and IT specialists while patients are left with lower levels of care. The new CPC+ program re-enforces the importance of the work we are doing today. 
 
The CPC+ program presents providers with similar staffing and technology challenges as chronic care management (CCM) services (99490). This positions Oculus Health to be one of the first technology providers to offer CPC+ services.
 
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CMS has outlined the following five key elements for CPC+:
  1. Services must be accessible 24/7
  2. Patients receive proactive relationship based care
  3. Care coordination happens across multiple providers
  4. Patient-centered and engages family and entire care team   
  5. Services are measured and analyzed 
The model has two tracks that pay doctors a bonus of $15 or $28 per patient per month. The incentive is to help keep chronically diseased patients healthy and out of the hospital. One of the requirements for the higher track is that the provider work closely with their IT vendor. The practice must submit a letter of support from an IT vendor that outlines their commitment to support the practice when optimizing their health IT.
 
Dr. Meena Seshamani the director of the administration's Office of Health Reform commented on the program saying, “Primary care doctors are under so much pressure right now. They just want to be able to practice medicine. We’re saying, take care of your patients the way you think is most effective, and you’ll be rewarded for good outcomes.”
 
In 2017 CPC+ will be implemented in 20 geographic areas. As of this articles publish date the areas have yet to be selected. CMS will offer both tracks one and two to all the areas that are selected for CPC+. The reasons the program is being implemented in only 20 areas to start is to test the new program before potentially increasing the program nationally. The goal of the program is to create better care for patients in the health care system. CMS believes that it will increase the cash flow for primary care practices while giving them the flexibility needed to deliver high quality care. The bonus is expected to help decrease total cost by reducing visits to emergency rooms and increasing the level of health received by patients. 
 

Conclusion

CPC+ is both a payment and care delivery model. It will require cooperation between technology providers and health care providers. We are excited about the prospect of providing a higher level of care to patients. Oculus Health is excited to provide full-service solutions for CPC+. We will keep you updated as new details emerge about the program.
 
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