
INSIGHTS FOR HEALTH CARE	JUNE 30, 2016

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Potentially Double Your Total Payments: Apply for CPC+ Today

We want to make you aware of a new advanced primary care medical home model that will provide significant value to eligible primary care providers. If you're interested, take action today because there's a very aggressive application timeline, as described below.

On April 11, 2016, the Centers for Medicare & Medicaid Services (CMS) launched Comprehensive Primary Care Plus (CPC+), the largest multi-payer initiative to improve the delivery of and payment for primary care. On or before July 15, 2016, CMS will select 20 U.S. regions to participate in the initiative. CMS will be soliciting practice applications for up to 5,000 providers within these regions July 15-Sept. 1, 2016. The initiative is designed to provide doctors the freedom to care for their patients with less required documentation while achieving the triple aim.

How Primary Care Practices Can Participate

Primary care practices (PCPs) can participate in one of two tracks. Practices will apply directly for the track they're interested in and eligible for. CMS can ask a practice that applied for Track 2 to instead participate in Track 1 based on lack of eligibility for Track 2. To participate, all CPC+ practices must garner multi-payer support, Certified EHR Technology (CEHRT), as well as meet other infrastructural requirements.

CPC+ practice eligibility criteria are as follows:

Track 1	Track 2
Practice structure and ownership information	Practice structure and ownership information
Use of CEHRT	Use of CEHRT
Payer interest and coverage	Payer interest and coverage
Existing care delivery activities must include: assigning patients to provider panel, providing 24/7 access for patients and support quality-improvement activities	Existing care delivery activities must include: assigning patients to provider panel, providing 24/7 access for patients and support quality-improvement activities, while also developing and recording care plans, following up with patients after emergency department (ED) discharge, and implementing a process to link patients to community-based resources
	Letter of support from health IT vendor that outlines the vendor's commitment to ensure the availability of electronic health information

Practices selected by CMS to participate in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs for which they will receive a monthly care management fee--a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. This hybrid payment design will enable the use of telemedicine to increase flexibility and efficiencies beyond traditional face-to-face office visits.

To encourage the delivery of high-quality and high-value care, at the beginning of the year, practices in both tracks will receive incentive payments that they will either keep or repay based on their performance on quality and utilization metrics at year-end. In addition, practices in both tracks will receive data on cost and utilization. Optimal use of Health IT and robust learning systems will support them in making necessary care delivery changes and using data to improve patient care.

Further details about the practice application will be made available following the selection of CPC+ regions. Interested practices will submit applications for CPC+ via an online application portal. Additional details about practice participation in CPC+ is available in the CPC+ Request for Applications.

Additional information about the CPC+ model, including a fact sheet, can be found here.

Assistance for Gaining Eligibility and Applying for CPC+

Based on an average cost-benefit analysis/performance-based outcomes, Track 2 participants can potentially receive nearly double the total payments compared to what they were receiving in a fee-for-service model-not to mention significant operational improvement benefits. Eide Bailly is teaming with Caravan Health to bring this opportunity to you. Caravan Health offers complimentary programs to help primary care providers become eligible and apply through webinars, workshops and application support.

An additional prerecorded webinar on CPC+ from Caravan Health can be found here.

Questions?

Please let us know if you're interested in these valuable resources from Caravan Health. We can provide you with additional information on CPC+, help guide you through the process and advise you on which alternative payment model is best for your organization. Contact Rhonda Quast at 701.476.8360 or rquast@eidebailly.com. Or reach out to your Eide Bailly professional.

Rhonda Quast
Health Care Consultant Senior Manager
701.476.8360

rquast@eidebailly.com

This publication is produced and published by Eide Bailly and distributed with the understanding that the information contained does not constitute legal, accounting or other professional advice. It is not intended to be responsive to any individual situation or concerns as the contents of the publication are intended for general informational purposes only. Readers are urged not to act upon the information contained in this publication without first consulting competent legal, accounting or other professional advice regarding implications of a particular factual situation. Questions and information for publication can be submitted to your Eide Bailly representative. To request reprints of this publication, send a written request to RequestReprints@eidebailly.com.
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