Multi-Payer Primary Care Transformation Continues to Expand

by Lisa Dulsky Watkins, Director of the Multi-State Collaborative

Starting in January 2017, multi-payer primary care transformation expanded in scale and scope to 14 states with the launch of the Comprehensive Primary Care Plus (CPC+) program. Demonstrating its deep commitment to improving the quality of primary care and tackling health care’s costs, the Centers for Medicare and Medicaid Services (CMS) and its Innovation Center (CMMI) have opened up a second application period for CPC+ participation. In January 2018, the second wave of CPC+ will bring the number of participating primary care practices up to 5,500 in as many as 24 markets in states and regions. This is an extraordinary opportunity to test the impact of the CPC+ project, which fundamentally consists of an agreement among participating payers in each market to:

• Implement common standards for transformed primary care;
• Align payment and measurement to all primary care practices participating in the program; and
• Provide technical assistance and support to participating practices.

CPC+ is at the cornerstone of accelerating CMS’s transition from fee-for-service payment to compensation based on performance metrics, patient experience, and patient outcomes. Participation in CPC+ gives primary care practices the opportunity to meet the higher standards of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, as these practices are recognized as being advanced alternative payment models (APMs).

The second wave of expansion builds on the Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration and the Comprehensive Primary Care (CPC) initiative, earlier and smaller scale CMMI programs implemented in 16 states and regions. Many of the more than 50 national, regional, public, and private payers in CPC+ have experience with MAPCP or CPC. In previous multi-payer primary care transformation programs, many programs saw improvements in the quality of delivered health care and reduced costs, and have signed on to continue these efforts in CPC+.

At the Milbank Memorial Fund, we have the unique vantage point of observing and connecting people working in participating regions—in particular the neutral parties who convene the payers. Whether they are new to this partnership with the federal program as in Montana, Kansas City, Philadelphia, Hawaii, or Tennessee, expanding into statewide activity in Oklahoma and Ohio, or refining their programs as in Arkansas, Colorado, Michigan, New Jersey, New York, Oregon, and Rhode Island, participants are motivated by a vision for the central role transformed primary care should play in a well-performing health care system.

CPC+ is unique among CMMI payment reform initiatives in its focus on aligning signals across payers, addressing one of the key points of frustration for any proponent of delivery system reform. The real, and hard, work of transforming primary care occurs locally, supported by state and national policy. At this regional level, unlikely partners, often competitors, are aligning key aspects of payment mechanisms and performance measurement, achieving outcomes they might not be able to on their own, and building collective will for other health reform efforts.

Payers interested in Round 2 have until April 3, 2017 to complete their applications. CMMI will then select markets for expansion and invite primary care practices to apply, in anticipation of the January 2018 start.