Comprehensive Primary Care Plus (CPC+)

Comprehensive Primary Care Plus (CPC+)

Practices selected to participate in CPC+ beginning January 1, 2017 have recently been notified of their acceptance into the program, and congratulations to all of you!

We have spoken with several such practices and the emotional rollercoaster starts off at a high, followed by the realization that they don’t know what they signed up for (and those who do don’t have a plan in place to succeed).

That’s where Oculus can help; but first, let’s break down the basics of the program:

What's the Point?

The goal of CPC+ is to improve the quality of care patients receive via:

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

Differences Financially:

To support the delivery of comprehensive primary care, CPC+ includes three payment elements:

Care Management Fee (CMF):
Both tracks provide a non-visit based CMF paid PBPM (Per beneficiary per month).
Performance-based incentive payment:
CPC+ will prospectively pay and retrospectively reconcile a performance-based incentive based on how well the practice performs.
Payment under the Medicare Physician Fee Schedule:
Track 1 continues to bill and receive payment from Medicare FFS as usual. Track 2 practices also continue to bill as usual, but the FFS payment will be reduced to account for CMS shifting a portion payments to CPC+. Given our expectations that Track 2 practices will increase the comprehensiveness of care delivered, the CPCP amounts will be larger than the FFS payment amounts they are intended to replace.

CPC+ Turn-key solution

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Integrated Practice Workflow

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24/7 Patient Engagement Center

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Remote Patient Monitoring

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Simplified Patient Messaging Tools

Let’s look at these further:

Care Management Fee:

When CMS assigns patients to a CPC+ practice, patients are assigned in one of the following risk tiers:

Risk Tier Attribution Criteria Track 2 Payment PBPM
Tier 1 1st quartile HCC Risk Scores $9
Tier 2 2nd quartile HCC Risk Scores $11
Tier 3 3rd quartile HCC Risk Scores $19
Tier 4 75-89% range HCC Risk Scores $33
Complex Top 10% HCC OR Dementia $100
Average   $28


Practices are being paid a monthly Care Management Fee AUTOMATICALLY for EVERY patient assigned to them. The fee will vary by what risk tier the patient falls into, but since they are categorized relative to each other, one can say that for every 1,000 patients assigned to a practice, the practice will be getting $28,000 per month in Care Management Fees.

Because of this, CPC+ patients are not permitted to bill for Chronic Care Management (CCM), because they are in effect being paid up front for the entire population.

Performance Based Incentive Payment:

Track 2 CPC+ practices are automatically paid a monthly bonus payment of $2.00 per patient assigned to them. There is a catch.

They are paid the entire amount up front, however performance is reevaluated at the end of each year, and if the practice did not perform up to that bonus level, they will need to pay CMS back whatever CMS says is owed.

Quality and cost savings is huge to say the least.

Comprehensive Primary Care Payment:

This is where remotely monitoring patients to ensure compliance, engaging patients outside of the practice, and providing frequent communication are paramount.

CMS is giving a percentage of the expected patient population E/M visits FFS (Fee-For-Service) revenue up front to practices in the form of Comprehensive Primary
Care Payments. These are paid quarterly to practices, and the percentage of anticipated FFS E/M revenue that is paid up front as CPCP, will be reduced from billed FFS E/M visits billed by the practice.

What does this mean?

CPC% / FFS% options by year:

Practices will benefit financially by using CMF funds to provide care out of the clinic, therefore reducing the overall number of E/M visits necessary to effectively care for the community.

2017 2018 2019 2020
10% / 90%      
25% / 75% 25% / 75% $11  
40% / 60% 40% / 60% 40% / 60%  
65% / 35% 65% / 35% 65% / 35% 65% / 35%

 

Click here for tools and understanding to determine which option is best for  you.

Partnering with Oculus for CPC+ Success

All of this new information, requirements, measures, reporting is daunting. We get it.

That is why Oculus has created a partnering solution specifically for CPC+ practices, ensuring success, and creating lasting and tangible value to your practice, your providers, and your patients.

 Contact Us to Learn More

FEATURES

1. Oculus has the flexibility to seamlessly integrate with the practice and provider’s existing workflow.

2. During the initial onboarding period, we identify various touch points within the workflow

3. Oculus is can automatically convert a patient’s EMR file to an electronic Care Plan for wellness, preventive, and Chronic Care Management.