Shared savings from the Comprehensive Primary Care (CPC) initiative’s second round are up. To be exact, the Centers for Medicare and Medicaid Services (CMS) report a total of $57.7 million in gross savings were generated in 2015 by 481 primary care practices serving more than 376,000 Medicare beneficiaries. Although three of the CPC regions had net losses, the savings generated in the other four regions covered those losses. Further, more than half of participating CPC practices will receive a share of over $13 million in earned shared savings.
The next step in the value-based primary care evolution is CPC+, which builds on the initiatives already in place. Here’s what you need to know.
Two tracks to choose from
Practices may participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, plus a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including systematic assessment and support of psychosocial needs. Practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or pay back to CMS, depending on their quality and utilization metrics. In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models beginning in 2019. Allocating resources to three key strategies can help practices maximize savings and, therefore, practice revenues.
1. Support for serious or chronic diseases
Disease management treats a specific issue in isolation, whereas care coordination treats patients’ medical issues in the context of one another, thereby involving regular, ongoing care and, as needed, other healthcare professionals. The average Medicare patient sees between 3 and 11 physicians in a given year, and 69% have two or more chronic medical conditions — CPC+ seeks to join up providers and conditions through coordination efforts specifically relying on primary care.
The primary care provider (PCP) is responsible for establishing — in concordance with the patient’s wishes — goals of care and care priorities. The plan for chronic disease management will be rooted in the decisions that meet the patient’s psychosocial and everyday needs. This plan should be periodically reviewed and revised, particularly when some aspect of the patient’s condition or life changes. For example, medication levels may be re-adjusted as the patient’s condition improves; or, for example, if the patient’s daily life changes due to having to provide care for a loved one. Strategies for the patient’s own self-care must be explored and developed.
2. Improved information exchange
Even the best patient documentation in the world is useless if access to information is difficult. Regular communication is necessary to flag up changes in the patient’s conditions. Communication must occur between the patient and PCP; and between PCP and other primary and specialist providers (e.g., dietitian, psychologist, cardiologist, diabetologist). Opening lines of communication is essential, and that means data-sharing.
Data management capabilities and information reliability make the coordination of information flow possible. Electronic health record (EHR) interoperability lies at the core of collaborative care; therefore, the creation of thorough patient documentation in the EHR can be strongly supported by using certified medical scribes. In addition to ensuring your EHR system works with those of other providers, sharing claims data with other providers can help them better understand what kinds of care are being provided. Thus they can respond in the context of multiple chronic illnesses, even those not in their specialty, and providers can use the shared information to collaborate to initiate preventive care efforts.
Sharing thorough and complete patient documentation can help providers further collaborate by developing clinical pathways — which involves setting standards and efficient paths of care. As a bonus, such efforts benefit the patient and reduce duplicative and unwarranted care resulting in reduced costs.
3. Integrate the patient and family in the care team
Patient care can be seen as a machine that requires many people to coordinate numerous moving parts — the motor of this machine is run by patients and their families. Thus, the PCP should provide them with links to community resources, tools for supporting and empowering self-management and family/carer involvement, and easy, 24-hour access to patient information.
The EHR is the melting pot of information on managing the patient’s care and serves as the foundation for empowering the patient to understand and manage their conditions. Primary care practices should create an online patient portal that gives patients access to all elements of their care plan and helps them manage their conditions. The portal should let patients to:
- Request/book appointments
- View test results and summaries of assessments
- Correspond with clinicians in a secure manner
- Send prescription-refill requests to clinician and/or pharmacy
- Access educational materials relevant to their diagnosis and medical condition
- Schedule e-visits and attend a clinical visit virtually
- Allow portability of the EHR
- View all staff who support and are involved in their care
The portal should be user-friendly, with an intuitive search function and perhaps even mobile-friendly.
“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,” says Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “This model allows primary care practices to focus on what they care about most — serving their patients’ needs when and how they choose.”