Comprehensive Primary Care Plus (CPC+) is an advanced primary care medical home model that rewards value and quality through innovative payments that support comprehensive care.
An initiative developed by CMS that transitionsMedicare fee-for-service to value-based payments in collaboration with Medicaid and commercial payers in selected regions.
Montana was 1 of only 14 regions selected across the country to participate with Medicare in this exciting 5-year test demonstration that will support primary care in our state. (7 additional payers in four regions were selected for CPC+ Round 2, beginning in 2018.)
Blue Cross Blue Shield of Montana, PacificSource, and Allegiance Life and Health have also partnered with Medicaid and Medicare in this model.CPC+ payer partners and providers are collaborating around the goals of smarter healthcare spending, more effective healthcare delivery, and healthier patients.
The CPC+ advanced primary care medical home model is centered on five key functions:
Access and Continuity;
Care Management;
Comprehensiveness and Coordination;
Patient and Caregiver Engagement; and
Planned Care and Population Health.
The program includes Track 1 and Track 2 practices.
Track 2 practices also receive alternative FFS payments starting in 2018 that they are required to use for non-traditional face-to-face visits.
Background of Montana’s CPC+ Participation
In August 2016, CMS chose Montana as a region to participate based on strong payer collaboration established through the Governor’s Healthcare Innovation Council and the Montana Patient-Centered Medical Home (PCMH) Program.
Montana primary care practices applied to CMS in September and 56 selected practices were announced in late November 2016.
Scale of Montana Participation
50 Montana practices signed up with CMS to participate in CPC+.
There are 22 practices in Track 1 and 27 practices in Track 2.
These include 6 independent practices and 25 rural practices, with an average of 7 clinicians per practice.
There are 11 of the practices (20%) participating in existing Medicare Shared Savings Program Accountable Care Organizations.
Medicaid and BCBS are offering their CPC+ programs statewide while PacificSource’s program is only in selected areas of the state. Allegiance was selected for Round 2, beginning January 2018.
Medicare and Medicaid’s programs launched January 1, 2017; BCBSMT and PacificSource programs began with various practices April 1, 2017.
Montana Medicaid has approximately 45,500 members attributed to CPC+ providers.
The Medicaid expansion (HELP) and Healthy Montana Kids (HMK) populations are both included in CPC+ as well.
Waivers: CPC+ care management will not replace or interfere with the case management provided to members in the waiver programs: SDMI, Autism (667), DDP 0208 (DD Comprehensive Waiver), Big Sky Waiver (SLTC Waiver).
Patient-Centered Medical Home (PCMH): Clinics cannot be both a PCMH and CPC+; they have to choose one program. Medicaid’s PCMH program will continue separately, adjust to align with CPC+.
Passport to Health and Team Care: Providers with members in Passport or Team Care must still follow all the same program rules and the members will still receive the program benefits but the CPC+ payments will replace the capitation payments for these programs.
Medicaid CPC+ Payment Plan:
Medicaid pays providers monthly care management fees (PMPM) based on members’ risk tier assignment.
Medicaid members are assigned a risk score through Medicaid’s predictive modeling risk software and divided into tiers based on their score of potential risk across the entire population.
Medicaid will retrospectively pay CPC+ practices annual performance-based incentive payments, based on a combination of utilization (i.e. ER visits and hospitalizations) measures and quality measures (i.e. A1C and blood pressure control).
Providers will be paid a quality bonus retrospectively at the end of the quality of care and utilization measurement period annually.
The amount will be based on the practice’s level of meeting the performance benchmarks, based on national standards and regional alignment with other payers.
Practices that meet quality and utilization thresholds will be rewarded with per member per year (PMPY) payments.
Track 2 Alternative Payment Method:
Payment under the Medicaid Physician Fee Schedule: Medicaid will pay alternative payments to Track 2 CPC+ practices using a partial Comprehensive Primary Care Payment (CPCP) that will be an up-front lump sum, replacing part of the expected fee-for-service payments for the coming year.
The Comprehensive Primary Care Payment (CPCP) will be calculated based on historical Evaluation and Management (E&M) services for attributed patients at the practice.
The calculation will look back two (2) historical years on total paid claims for E&M services only, for attributed patients at the Track 2 CPC+ Practice.
Alternative Payment Method to Track 2 practices to begin approximately July 1 st, pending CMS approval:
Payment Method
2017
2018
2019
2020
2021
FFS%
100%
90%
90%
60%
60%
CPCP%- up front
0%
10%
10%
40%
40%
Track 2 CPC+ practices must offer at least one alternative type of access to the patient’s care team in ways that best meet the needs of the Medicaid population. Alternative types of visits include:
e-visits;
phone visits;
group visits;
alternate location visits (i.e. community center, library, etc.);
expanded hours in early mornings, evenings, and weekends.
The Montana CPC+ Practices Selected by CMS and Participating with Medicaid are Listed Below:
Billings Clinic Downtown
Billings Clinic Heights
Billings Clinic West
Bozeman Health Internal Medicine Clinic
Bozeman Health Family Medicine Belgrade
Bozeman Health Family Medicine Clinic
Central Montana Medical Facilities, Inc.
CPG Family Medicine & OB
Community Physician Group North Primary Care
Community Physician Group Stevensville
Craig L. Treptow, M.D.
Family Medicine Center of the Bitterroot, P.C.
Glacier Medical Associates
Great Falls Clinic Family Medicine
Great Falls Clinic Main
Great Falls Clinic Northwest
Kalispell Regional Medical Center (KRMC) Big Sky Family Medicine
KRMC Bigfork Medical Clinic
KRMC Family Health Care
KRMC Family Health Care - Columbia Falls Clinic
KRMC Kalispell Medical Offices and Bone Health
KRMC Northwest Family Medicine
KRMC Polson Health Clinic
KRMC Westshore Medical Clinic
KRMC Woodland Clinic
Lame Deer Dept of HHS
Melchisedek L. Margaris, M.D., FAAFP
Providence Medical Group - Florence Family Medicine
Providence Medical Group - Grant Creek Family Medicine
Providence Medical Group - Lifespan Family Medicine
Providence Medical Group - Missoula Family Medical
Providence Medical Group - Montana Internal Medicine
Providence Medical Group - Providence Broadway Internal Medicine
Providence Medical Group - Women's Care & Family Wellness
SCL Health Medical Group - Mountain View Clinic
SCL Health St. V Medical Group - Billings LLC - Broadwater Family Medicine
SCL Health St. V Medical group - Billings LLC - Laurel Family Medicine
SCL Health Medical group - Billings LLC Saint Vincent: Hardin Family medicine
SCL Health Medical group - Billings LLC Saint Vincent: Heights family practice
SCL Health Medical group - Billings LLC Saint Vincent: North Shiloh Medicine
SCL Health Medical group - Billings LLC: Internal Medicine
SCL-Health Medical Group - Billings - West Grand Family Medicine
St. James Physician Billing
St. Peter's Medical Group - Broadway
St. Peter's Medical Group - North
Stevensville Family Medicine (Kirk Crews Storybrook Medicine)
