How Oregon Created a CPC+ Collaborative

Oregon is like a lot of markets participating in the Comprehensive Primary Care Plus (CPC+) initiative, Medicare’s national payment reform model developed to strengthen primary care through multi-payer alignment, payment reform, and care delivery transformation. Payer participants in the state’s initiative know that they need to function as a “collaborative” if they are to meet the goals of the project—to help participating primary care practices transform the way they deliver care.

As participants in the original Comprehensive Primary Care (CPC) initiative, the state noted a significant reduction in expensive health care services for Medicare patients in 64 primary care practices, including fewer hospital admissions and emergency department visits.

When the opportunity arose to participate in CPC+ and expand this work, 14 commercial payers from all corners of the state applied and were accepted, with three more planning to join by 2018. To handle the logistics of working with such a large group, the payers decided that they needed an independent, neutral convener or organizer to guide them through the process. The role of the convener in facilitating collaboration among organizations that spend most of their working day competing with one another emerged as critical in CPC—particularly in larger markets.

The payer group selected three organizations to fulfill that convener function—Artemis Consulting, which focuses on health policy; the Oregon Health Care Quality Corporation (Q Corp), a regional health improvement collaborative; and the Oregon Health Leadership Council, a collaborative of health plans, hospitals, and physicians.

“Working with a diverse group like this, it’s critical to establish shared goals and purpose to ensure a clear understanding of what the payer group wants to accomplish,” said Diana Bianco, principal of Artemis Consulting. “We all agree that we want to advance primary care while decreasing the burden on already stressed practices. Together, we’re figuring out how we do this as a collaborative that seeks alignment, joint learning, innovation, and statewide impact.”

Before the group had its first meeting, the conveners conducted a survey to gauge individual payer priorities and expectations, as well as to determine often challenging logistics like meeting times and locations. At the May 2017 kickoff meeting, all 14 payers were represented, most of them in person.

“The spirit of commitment and collaboration at the meeting was impressive,” said Bianco. “Seven of the 14 payers volunteered to be on a Steering Committee, which will involve extra effort on their parts. They also unanimously agreed to invite the three new 2018 payers to their meetings starting immediately. They even reached agreement on the provisional principles of a charter, which the group charged us with drafting.”

Bianco notes that challenges remain. Because of the size of the state, setting up meetings requires creativity and efficient technology to ensure that everyone can participate, even if they cannot attend in person, she explained. Also, the number and variety of participating payers could make finding agreement on difficult issues a longer process. But Bianco is optimistic.

“I’m looking forward to diving into the hard work of finding a shared set of quality metrics and identifying data aggregation solutions, even if it’s just agreeing on the principles at first,” said Bianco “And I am excited about establishing a strong collaborative process from the start, where the payers set the agenda for their priorities and how they want to work together. In fact, that’s already taking place. Just last week, several payers started an email discussion on strategies to support the more advanced clinics, known as “Track 2” practices. They reached out to me to put the subject on our next agenda, which we’ll do to discuss promising and coordinated approaches. That tells me we’re off to a good start.”

One of the payers, Jim Rickards, MD, MBA, Chief Medical Officer, Health Policy and Analytics Division, Oregon Health Authority, added, “I’m excited to see robust participation in CPC+ by our Medicaid managed care entities known as coordinated care organizations (CCOs). The efforts of CCO’s, commercial payers, and Medicare in Oregon to improve quality of care and provider satisfaction by aligning payment models will help us build on the success of our coordinated care model.”