If you are a primary care practice operating in one of 14 selected CPC+ regions (see list below) you may be eligible for a unique opportunity to earn significant additional revenue from multiple payers (e.g., Medicare, Medicaid, and Commercial) by participating in the Comprehensive Primary Care Plus (CPC+) program that will start January 1, 2017 and last for five years.
Time is of the essence as interested primary care practices must submit an application to CMS by September 15, 2016.
Who is eligible?
Eligible CPC+ practitioners are those who have a primary specialty designation of family medicine, internal medicine, or geriatric medicine, and for whom primary care services accounted for at least 60 percent of billing under the Medicare Physician Fee Schedule and have a minimum of 150 attributed Medicare fee for service beneficiaries in one of the 14 CPC+ Regions (see below).
Practices owned by hospitals and health systems are eligible to apply to CPC+.
Practices within an IPA are eligible to apply to CPC+. Practices within an IPA must apply separately to participate in CPC+, as CPC+ is a practice-level transformation
Primary care practices currently participating, or considering participation in Tracks 1, 2, or 3 of the Shared Savings Program, that meet the eligibility requirements of CPC+, may participate in both initiatives. Practices participating in Shared Savings Program Accountable Care Organizations (ACOs) can participate in either track of CPC+.
Practices within ACOs participating in the ACO Investment Model (AIM), Next Generation ACO Model, or other shared savings programs may not participate in CPC+.
Also not eligible for CPC+: FQHCs, Rural Health clinics, and concierge practices, or any practice that charges patients a retainer fee as of January 1, 2017, may not participate in CPC+.
CPC+ Regions
1. Arkansas: Statewide
2. Colorado: Statewide
3. Hawaii: Statewide
4. Kansas and Missouri: Greater Kansas City Region
5. Michigan: Statewide
6. Montana: Statewide
7. New Jersey: Statewide
8. New York: North Hudson-Capital Region
9. Ohio: Statewide and Northern Kentucky: Ohio and Northern Kentucky Region
10. Oklahoma: Statewide
11. Oregon: Statewide
12. Pennsylvania: Greater Philadelphia Region
13. Rhode Island: Statewide
14. Tennessee: Statewide
Two CPC+ Options – Track 1 and Track 2
Practices will have two program options – Track 1 and Track 2. Care delivery requirements for each track are:
Track 1
Existing care delivery activities must include: assigning patients to provider panel, providing 24/7 access for patients, and supporting quality improvement activities.
Track 2
Existing care delivery activities must include: assigning patients to provider panel, providing 24/7 access for patients, and supporting quality improvement activities, while also developing and recording care plans, following up with patients after emergency department (ED) or hospital discharge, and implementing a process to link patients to community based resources
CPC+ will accommodate up to 2,500 practices in each track for a total of 5,000 practices across all regions and encompass approximately 20,000 clinicians and 25 million patients
CMS expects practices that participate in CPC+ will do so for the full five years of the model. However, participation in CPC+ is voluntary and practices may withdraw from the model without penalty during the five-year program period.
Practice Additional Revenue Projections
Additional revenue can be significant for participating practices
For Track 1 and Track 2 participants – projected average payments are shown below (per beneficiary per month)
| Track | Care Management Fees PBPM | Performance based Incentive Payments | |
| 1 | $15 average | $2.50 PBPM | |
| 2 | $28 average | $4.00 PBPM | |
These payments are in addition to fee-for-service payments.
Per 1,000 patients, the maximum payments for care management fees for Track 1 participants would be $210,000 and $384,000 for track 2 participants.
Technology requirements and eTransX
Use of advanced technology will be critical for maximizing revenue in the CPC+ program – particularly for Track 2 participants.
eTransX offers Comprehensive Primary Care Plus software and seeks to partner with practices applying to participate in the CPC+ Model Track 2 leveraging our comprehensive, modular XCare Community software system.
Our Comprehensive Primary Care Plus software offering can act as a total solution or fill in the gaps for those products and/or services that you do have. Specific CPC+ Track 2 functions addressed by our XCare Community system (software-as-a-service) offering include:
- Developing a personalized care management plan for patients with complex medical, behavioral, and psychosocial needs.
- Managing referrals and services orders with community based service organizations to coordinate services for patients with complex needs.
- Risk-stratifying practice site patient populations: identify and flag “patients with complex needs”
- Capturing and tracking certified quality measures results at the practice level to support continuous feedback
- Systematically assessing patients’ psychosocial needs and developing and maintaining an inventory of community resources and supports to meet those needs
- Documenting and tracking patient reported outcomes
- Developing and manage follow-up care plans for patients after discharge from emergency department (ED) or hospital stays.
Please call us today to find out more on how eTransX can help with your CPC+ initiative.
Richard Taylor 615 620 7524 – rtaylor@etransx.com
