Hawaii chosen as region for new primary care initiative

by Zack Hale, State of Reform, August 1, 2016

The Centers for Medicare and Medicaid (CMS) on Monday announced that Hawaii will be one of 14 regions for its new primary care quality improvement initiative, which aims to pay providers for achieving results and improving care in lieu of a traditional fee-for-service model.

Starting in January 2017, the five-year initiative will launch with the goal of having 50 percent of all Medicare fee-for-service payments made via alternative payment models by 2018.

Comprehensive Primary Care Plus (CPC+) offers two tracks for providers to choose from with different care and delivery requirements and payment methodologies.

Track 1 practices will receive a care management fee that averages $15 per beneficiary per month. This track is similar to CMS’s original Comprehensive Primary Care (CPC) model, but the agency has refined eligibility criteria, care and delivery requirements and incentive payment opportunities to incorporate the lessons taken from the initiative.

Track 2 targets practices that are proficient in CPC that are prepared to increase the depth, breadth and scope of Medicare care delivered to patients, with a focus on patients with complex needs. Under this track, payment is resigned to be a hybrid of fee-for-service paid at the time of visit and fee-for-service prospectively paid. Track 2 practices will also receive an enhanced care management fee averaging $28 per beneficiary per month to support care management, enhanced to support the more stringent requirements for Track 2 practices and to enable for comprehensive care for patients with complex needs.

The other states selected for the initiative include Arkansas, Colorado, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee.

CMS selected the markets based on density and interest shown by practices and payers.

CMS has also selected 57 not-yet-named payers, which it has invited to commit to align on payment, data sharing, and quality metrics throughout the initiative.

Eligible practices in the CPC+ regions may apply for participation in one of the two tracks. CMS will review applications and select successful practices in October of this year.

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