When the Center for Medicare and Medicaid Services announced its new Comprehensive Primary Care Plus (CPC+) payment model, the announcement was mired by protestations from prominent investor and Venrock partner and former White House policy advisor Dr. Bob Kocher and former National Coordinator for Health IT Dr. Farzad Mostashari, who called out CMS for excluding ACOs from the initiative. On Friday, CMS Acting Administrator Andy Slavitt announced via Twitter that CMS would change course and allow a limited number of ACOs, under the Medicare Shared Savings Program but not the Next Generation ACO program, to participate in CPC+.
GOOD NEWS: Choose a Medical home? Choose an ACO? Why choose? Just announced with CPC+, you can do both. Good feedback and a quick response.
— Andy Slavitt (@ASlavitt) May 27, 2016
In addition to the tweet, CMS released an updated FAQ that detailed exactly how the change would work. The FAQ explained that only a maximum of 1,500 of the 5,000 CPC+ practices will be allowed to be ACOs. If more ACOs than that apply, they'll be subjected to a lottery. This is to ensure that a large influx of ACOs doesn't edge out other would-be participants in the model. The FAQ also explains how payments will work for practices that are both ACOs and CPC+, and that they will be responsible for both programs' quality reporting requirements.
"CPC+ACO is a smart policy," Kocher wrote on Twitter in response to Slavitt. "By listening to doctors, CMS is creating a better model to improve quality and cost!"
CPC+ACO is a smart policy. By listening to doctors, CMS is creating a better model to improve quality and cost! https://t.co/eisVP5tkaY
— Bob Kocher (@bobkocher) May 27, 2016
Mostashari also responded positively, linking to a piece that he, Kocher, and Dr. Mark McClellan, director of the Robert J Margolis Center for Health Policy at Duke University, wrote earlier this month explaining the need for ACO involvement in CPC+.
CMS IS LISTENING!!!!!
— Farzad Mostashari (@Farzad_MD) May 27, 2016
"[B]y requiring physicians who want to transform their practice to choose CPC+ instead of an ACO to get up-front support in doing so – and on top of that by not requiring them to show impacts on population health outcomes and spending – this policy likely will slow the adoption of accountability for total cost of care by primary care providers," the three wrote in an article for Evidence Base.
"Further, as noted above, the evidence is at best mixed that CPC+ will succeed as designed," they continued. "While it provides more refined and in some ways greater support than CPC, the CPC+ practices will have no specific incentive to lower the total cost of care. If many practices do not actually execute CPC+ care in a manner that lowers total cost of care, thereby increasing health care costs for beneficiaries, the pilot may well end up raising total Medicare spending, which in turn would result in its termination – necessitating yet another pilot in a few years to help primary care physicians move to better care models."
Mostashari, Kocher, and McClellan conclude that even if the CPC+ACO model doesn't ultimately improve outcomes and costs, it makes sense to include ACO docs in a pilot program, because it will give CMS as much information as possible about what works and what doesn't. They'll have data from CPC+ practices, ACOs, and practices involved in both.