Sweeping CMS Initiative Bodes Well for Future of Home Health

A sweeping new initiative from the Centers for Medicare & Medicaid Services (CMS) may focus on primary care, but it appears to bode well for the future of home health and community-based services.

The Comprehensive Primary Care Plus (CPC+) model is a new Affordable Care Act (ACA) initiative and CMS’ largest-ever multi-payer initiative to improve primary care nationwide, the agency announced Monday. The five-year CPC+ model will be implemented in as many as 20 regions and can accommodate up to 5,000 practices, which would involve more than 20,000 doctors and clinicians and the 25 million individuals they serve.

Under CPC+, CMS will pay practices a monthly fee to manage care for up to 25 million Medicare beneficiaries. To promote high-quality and high-value care, the practices will either get to keep or have to repay the up-front incentive payments based on their performance on utilization and quality metrics. The payments under this model encourage physicians to concentrate on health outcomes, as opposed to the volume of tests or visits, CMS said.

And although the initiative is ultimately meant to improve cost and quality while granting doctors and patients more control over health care delivery, it spotlights and encourages the use of home health, telemedicine and community-based services.

As part of the CPC+ model, Medicare will partner with state and commercial health insurance plans to support primary care practices in delivering advanced primary care. In advanced primary care, services are accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in-person hours and 24/7 electronic or telephone access, CMS said. Advanced primary care also involves coordinated care across the health care system, including community services, and patients receiving timely follow-up after hospital or emergency room visits.

“Strengthening primary care is critical to an effective health care system,” Patrick Conway, CMS’ deputy administrator and chief medical officer, said in a prepared statement. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”

Regions that demonstrate sufficient interest from multiple payers will be selected to participate in CPC+, CMS said. The agency plans to enter into a Memorandum of Understanding (MOU) with selected payer partners to document a shared commitment to align on payment, quality metrics and data sharing in CPC+.

Payer proposals to partner in CPC+ will be accepted between April 15 and June 1. CMS will then accept practice applications in the determined regions between July 15 and September 1. The model is scheduled to start in January 2017.

Written by Mary Kate Nelson