Opportunities for health tech in CMS' new value-based payment model for primary care

By Jonah Comstock
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CMS has announced a new expanded initiative for bringing value-based repayment to primary care. The Comprehensive Primary Care Plus (CPC+) program, builds on the Comprehensive Primary Care program introduced in 2012, but will expand the program to a larger number of practices and includes some tweaks to the model. 

“Strengthening primary care is critical to an effective health care system,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”

CMS will also work with private payers to set up a system that can support 5,000 primary care practices in 20 different regions of the country. They’ll be set up in one of two tracks, both of which will receive some payment in the form of a monthly care management fee for each of their Medicare patients, and bonus payments for meeting certain performance measures. In Track 1, practices will continue to receive regular Medicare fee-for-service payments for covered services while Track 2 will use a hybrid fee-for-service/value-based model.

Providers that participate in the program will be required to offer certain things to their patients, some of which incentivize use of certain technologies. For instance CPC+ practices will have to make care available to patients 24/7, which is a clear opportunity for telemedicine. Other requirements include proactive, relationship-based care management for high-risk patients; preventative care; incorporation of the patient’s family into the care process; and measuring quality and utilization of services.

Former National Coordinator for Health IT Farzad Mostashari, who is currently CEO of Aledade, which helps primary care docs launch accountable care organizations, tweeted that the “new CPC+ payment model would massively increase financial feasibility of eVisits for regular primary care docs.”

But he also had some concerns about the model, noting that the amount of money actually being tied to performance measures in CPC+ seems small and “not close to being shared risk”. He also agreed with Venrock partner Dr. Bob Kocher, who complained that doctors who are already in an ACO can’t participate in the program.

The American Academy of Family Physicians lauded the new payment model, saying that it helped mitigate difficulties that primary care practices face in trying to innovate care.

“Comprehensive medical services that provide preventive care, diagnosis and treatment of an acute illness or management of a complex chronic condition require large investments,” Dr. Wanda Filer, president of the AAFP, said in a statement. “Physicians who are redesigning their practices must purchase or upgrade electronic health records, reconfigure or add medical office staff, and commit additional time for communication with subspecialists, pharmacists, hospitals, home care agencies and therapists. They also require new payment models for primary care physicians that support and facilitate these services and functions. These services and the supporting payment models are vital to ensuring that patients get the right care from the right health professional at the right time.”

Dr. Joseph Kvedar, vice president of Connected Health at Partners HealthCare in Boston, told MobiHealthNews he thinks CPC+ will promote smart technology use for primary care providers.

“We’ve shown over and over that if you use technologies to link patients to their providers and you use those same tools to give those patients and consumers a path to improve their health on their own, you can change utilization in very fundamental ways that allow you to spread your primary care resources across a larger panel size,” he said. “And as we move to these new models of care delivery, primary care practices are going to win the day by taking on more patients, more covered lives, larger panel size. You can’t do that and just conduct business in the same old way, because everyone is already complaining and patients are feeling rushed. The only way to do it is to think about new ways to leverage technology.”