Strengthening Primary Care Through Payment and Care Delivery Transformation

Comprehensive Primary Care Plus (CPC+) Implementation

By Chris Beadles

Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model sponsored by the Centers for Medicare & Medicaid Services (CMS) that aims to strengthen primary care through regionally based, multi-payer payment reform and care delivery transformation. CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States. Currently, there are approximately 3,000 providers and more than 60 payers participating.

RTI worked with CMS to help develop and execute payment policy for the CPC+ project. CMS is testing an innovative pay for performance (P4P) model that has several unique features, including prospective full payment from CMS, transparent targets for quality and utilization prior to the performance year, and retrospective recoupment from practices if they do not meet the targets.

RTI helped CMS to design and implement the performance-based incentive payment (PBIP). Our work has improved CMS’s understanding of the implications of potential policy alternatives. RTI performs quick and accurate analyses, often on large claims databases, to answer complex policy questions.

RTI not only generates evidence-based insights through data analysis but also builds consumer-friendly interactive tools for CMS to support their decisions on the PBIP design. Our expertise allows practices to focus on the job they do best—providing high quality care—while we help them implement alternative payment systems and monitoring (including best practices, addressing risks, and legislature and regulatory changes).

RTI also provided support for stakeholder inquiries and communications; beneficiary attribution; payment calculations; quality measurement and reporting; and program management, logistics, and quality assurance.

This is an ongoing project aiming to strengthen primary care in the U.S. through regionally based, multi-payer payment reform and care delivery transformation.