Here are nine highlights:
1. The model, Comprehensive Primary Care Plus, begins in January 2017.
2. The five-year plan will include up to 5,000 practices and 200,000 physicians in nearly 20 regions.
3. CMS’ model will pay participating physicians under two tracks. The tracks will provide practices up-front incentive payments the physicians will either keep or repay based on their quality performance and utilization metrics.
3. Under Track 1, CMS pays practices a monthly care manage fee as well as fee-for-service payments under the Medicare Physician Fee Schedule.
4. Under track 2, physicians may deliver care outside of the standard face-to-face office visits. Physicians in Track 2 will also receive a monthly care management fee, but will receive reduced Medicare fee-for-service payments and up-front comprehensive primary care payments.
5. Track 2 allows physicians to administer more comprehensive services for patients with complex medical and behavioral health needs.
6. Under Track 2, vendors will sign a Memorandum of Understanding with CMS, detailing their commitment to supporting the enhancement of health IT capabilities.
7. Comprehensive Primary Care Plus five key parts include:
• Services are accessible through in-person hours or electronic access
• Patients deemed high-risk receive proactive care management services
• Preventative services are available for comprehensive physical and mental care
• Care is coordinated
• Patients get a timely follow-up after emergency room or hospital visits
8. Until June 1, CMS will accept payer proposals to partner in Comprehensive Primary Care Plus.
9. From July 15 to Sept. 1, CMS will accept practice applications in the determined regions.
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