CPC+ and Oculus Health: Improving Primary Care Delivery for Americans


Better Primary Care, Better Health Care

 The Centers for Medicare and Medicaid Services (CMS) developed CPC+ (Comprehensive Primary Care Plus) to strengthen primary care through multi-payment reform and improved care delivery. This primary care medical home model is regionally-based, addressing critical gaps in primary care quality and delivery in the areas of the U.S. that need it most:

  • Louisiana
  • Nebraska
  • North Dakota
  • New York: The Greater Buffalo Region

Healthcare reform is top-of-mind for politicians, physicians, and patients in America. In the last decade, the focus has turned to primary care. Without access to comprehensive, affordable primary care, patients unknowingly contribute to overflowing emergency rooms and rising healthcare costs -- creating an endless ‘chicken and egg’ cycle that CPC+ strives to stop.

CPC+ and Oculus Health: Improved Primary Care in 3 Parts

1. Ensuring Primary Care Access

CMS acknowledges that access to primary care is not the result of a lack of coverage. More Americans have health insurance coverage than ever before. However, there is a shortage of places to go to get primary and preventative care services in the United States.

Americans living in remote or rural areas of the U.S. cannot receive the care they need from overburdened primary care physicians in their regions. Primary care practices in these areas are overwhelmed with the number of patients and the extent of their patients healthcare needs.

Without primary care access, these patients -- both insured and uninsured -- neglect their care and go to emergency rooms, paying significantly higher healthcare costs, receiving less adequate care, and contributing to backlog at these overcrowded emergency centers.

The CPC+ multi-payer model will provide the 3,891 participating primary care practices across 18 regions (launched in two rounds) with the flexibility they need to make investments that will improve quality of care and reduce the number of unnecessary services that their patients receive.

CPC+ creates financial flexibility by providing primary care practices with two tracks under the Medicare Physician Fee Schedule:

  • Track 1: Continues to bill and receive payment from Medicare FFS, improving care delivery and patient outcomes while reducing overall healthcare costs.
  • Track 2: Practices will increase the comprehensiveness of care delivered. The Comprehensive Primary Care Payment amounts will be larger than the Medicare FFS payment amounts they are intended to replace, allowing participating practices to deliver better care for high risk patients.

Oculus Health supports CPC+ to ensure primary care access with their Annual Wellness Visit Solution: 

  • Provides the infrastructure to manage and implement successful patient preventative service schedules.
  • Responsive AWV module greatly reduces the average 90 minute time for the exam.
  • Provides templates for 2nd level screenings such as depression and alcohol counseling, eliminating the need to create a new workflow.

2. Comprehensive Care Delivery and Management 

America has the highest obesity rates of any country in the world -- nearly 40%. Obesity results in cardiovascular problems such as chronic lower back pain, high blood pressure, heart disease, liver disease, and stroke. Over time, the obese Americans have difficulty maintaining personal hygiene, leading to slew of other health complications.

Unhealthy lifestyles left unchecked by primary care physicians results in roughly $150 million in healthcare spend, primarily in emergency rooms.

Beyond access to primary care, patients suffering from chronic illnesses need detailed care plans and follow up. Facilitating these visits and creating new workflows depletes time and financial resources.

CPC+ alleviates the costs associated with this follow-up through the Care Management Fee:

  • A non-visit based Care Management Fee (CMF) is provided under both tracks paid per beneficiary per month.
  • This allows primary care practices to be compensated for their time when managing care plans for chronically ill patients.

Oculus Health supports CPC+ through Chronic Care Management: 

  • Places all treatments and instructions in the hands of the patient without creating new workflows.
  • Facilitates remote, non-visit based, engagement with patients on an ongoing basis.
  • Follow-up ensures compliance, gets patients actively involved in managing their own health, and identifies problems before they become an emergency.
3. Planned Care and Improved Population Health

The overtaxed, overburdened emergency rooms and primary care practices result in poor quality of care. The focus shifts from quality of care to speed of care when the existing health care model is designed to serve as many people as possible without consideration for efficiency. 

The CPC+ flexible multi-payer model and new Care Management Fee assist in alleviating some of this burden. More financial flexibility allows primary care practices to hire more resources, take on more patients, and leads to better quality of care.

This is why CPC+ has introduced a performance-based incentive payment. 

  • The performance-based incentive payment will prospectively pay and retrospectively reconcile and performance-based incentive based on how well the practice performs.
  • Ensures additional financial relief to the primary care practices who are effectively implementing CPC+. 

Oculus Health helps primary care practices achieve the CPC+ performance-based incentive payment through Transitional Care Management: 

  • To qualify for the incentive or for any of the reimbursements offered through CPC+, physicians must carefully document all patient interactions, including non-visit based care.
  • Transitional Care Management (TCM) provides comprehensive data tracking, querying options, and reporting capabilities
  • TCM provides 24/7 accessibility management services through enhanced remote communication capabilities
  • Provides critical support for continuity of care management and the coordination of care, ensuring documented improvement in the quality of primary care practices.

CPC+ and Oculus Health work together to enhance primary care delivery and put quality, accessible health care in the hands of more patients in the United States. Learn more about what you can do to achieve excellence in healthcare at blog.oculushealth.com.

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