The Care Transformation Collaborative of Rhode Island (CTC), a patient-centered medical home initiative managed by UMass Medical School, is one of 14 regions selected by the Centers for Medicare & Medicaid Services (CMS) to participate in its largest primary care improvement initiative.
Comprehensive Primary Care Plus (CPC+) is a five-year medical home model for primary care practices that begins in January 2017. The multi-payer model is a partnership between Medicare, state Medicaid agencies and private insurance in each selected region.
“This is a great opportunity for primary practices that have not yet adopted the patient-centered medical home model of care. It’s important for us to support primary care practices so that they can move toward alternative payment models that align with Medicare and the Rhode Island Office of Health Insurance Commissioner,” said Debra Hurwitz, MBA, BSN, RN, co-director of CTC and associate director of program development in the Office of Program Development within UMass Medical School’s Commonwealth Medicine division.
The Office of Program Development has been providing project management support for CTC since 2011.
CTC is the only New England participant in CPC+, which aims to help practices prepare for advanced alternative payment models through the Quality Payment Program proposed by CMS. The model moves clinicians away from a fee-for-service system to payments that support comprehensive primary care and reward value and quality.
In order to participate in CPC+, regions had to demonstrate multi-payer support and willingness to participate in the effort. The UMass Medical School team led efforts to alert stakeholders of the opportunity, share specifics of the initiative and assist with preparing the application. CMS has selected and confirmed the initiative’s three payer partners, including Blue Cross and Blue Shield of Rhode Island, Rhode Island Medicaid, and UnitedHealthcare.
“There was hesitance among the health plans to participate because they wanted to make sure that the initiative would align with state-wide efforts to support Accountable Care Organizations (ACOs). After listening to concerns and tailoring the application to their needs, we were able to garner support from the state and the health plans,” said Susanne Campbell, RN, MS, PCMH CCE, a senior project director in the Office of Program Development.
In Rhode Island, unaffiliated primary care practices that participate in this new CMS initiative will automatically be included in the 2017 expansion of CTC, which provides additional assistance and support to those practices.
According to CMS, CPC+ will help primary care practices better support patients with chronic diseases, deliver preventative care, coordinate care across settings and specialists and provide 24-hour access to care and health information.
To support those goals, practices will receive a blend of fee-for-service Medicare reimbursements and monthly capitations, or payments per patient. All practices will be eligible to receive payment incentives based on quality and utilization performance.
“Practices will be able to be innovative in ways they were reluctant to do in the past because of the fee-for-service payment model,” Campbell said. “This initiative will allow them to consider the needs of the population and how to design programs to meet those needs as well as cut costs.”