Have you heard about or begun work with CPC+ or the Annual Wellness Visit (AWV)
I work in an outpatient diabetes pharmacotherapy clinic called the Silver Clinic that is part of a patient-centered medical home called the Family Medicine Center (FMC). The FMC is part of a payment redesign by payers, both public and private, through Centers for Medicare and Medicaid Services (CMS) called Comprehensive Primary Care Plus (CPC+).
The idea behind CPC+ is to reform and strengthen primary care to keep patients out of the emergency rooms and hospitals.
https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus
The idea is to reform primary care to keep patients healthy and out of the emergency rooms and hospitals. It sounds like CMS is moving toward prevention rather than pay for service.
"CMS believes that through mulit-payer payment reform and practice transformation, primary care practices will be able to build capabilities and care processes to deliver better care, which will result in a healthier patient population. In its first year, CPC achieved gross savings and was nearly cost neutral, with positive quality results. CPC+ looks to build on these results." [reference: CPC+ Practice FAQ]
CPC+ is currently implemented in 14 regions throughout the US.; Oklahoma is one of those regions. The purpose of CPC+ is to ensure that primary care practices receive adequate support from muliple insurers to change care delivery for a practice's entire panel of patients. In Oklahoma the payers that have been selected to partner in CPC+ are Advantage medicare Plan, BlueCross BlueShield of Oklahoma, CommunityCare HMO, Inc., Oklahoma Medicaid, UnitedHealthcare.
CPC+ includes two primary care practice tracks with different advanced care requirements and payment options in each track. Those sites with sicker, more complex patient care can qualify for track 2. Because of the complexity of our patients, both those with and without diabetes, the FMC is a part of track 2. Payment is based on quality and utilization outcomes; like keeping people out of the hospital and making sure they are receiving appropriate screening and meeting clinical outcome goals.
The FMC received CMS funds up-front to develop infrastructure for traditionally non-billable services as part of the CPC+ initiative with the purpose being to keep our patients healthier and out of the hospital and emergency room. In our case, behavioral health and transitions of care management were among the first services implemented.
And although it is not funded by the CPC+ funds because it is a billable service, we in the Silver Clinic were asked to begin doing AWVs to essentially keep our patients healthier and at less risk. Myself as an RD and the PharmDs in our clinic began providing this service in June. I will share my experience with the AWVs in future blog posts but for now I want to hear from you.
What do you know about CPC+?
Are you working at a site that is part of the restructuring of primary care and if so, what part are you playing?
Are you providing AWVs in your setting and if so, for whom and what is the process?