CPC+

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2017 Care Coordination Forum November 7th, 2017

Comprehensive Primary Care Plus’ Impact on Care Coordination Caroline Carter, MS, LSW, BCC CPC+ Practice Facilitator Healthcare Collaborative of Greater Columbus


CPC+ Learning and Emerging Work


Session Objectives • Define Comprehensive Primary Care+ (CPC+) • What investment is CPC+ making toward care coordination at the primary care level? • Discuss how the broader community can support practices participating in CPC+




Ohio - Northern Kentucky Region • 562 Practices • 2,600 Physicians • 4 million patients • Medicare and 12 Private Payers


National and Regional Learning CPC+ Practice Portal Online tool for reporting, feedback and assessment on practice progress. Actionable data reports on attribution and cost, utilization and quality at practice and patient level

Learning Communities National webinars and annual National Stakeholder Meeting • Cross regional collaboration • National learning opportunities

Virtual and in-person regional learning sessions Web-based platform for CPC+ stakeholders to share ideas, resources and strategies for practice transformation

• Engagement with CPC+ stakeholders. • Outreach and support from regional learning faculty


Framework for Payer Partnership Enhanced, non-fee-for-service support for Track 1 & 2 practices to meet the aims of the care delivery model Change in cash flow mechanism from fee-forservice to at a least a partial alternative payment methodology for Track 2 practices Performance-based incentive payments for Track 1 and 2 practices

Aligned quality and patient experience measures with Medicare FFS and other payers in the region Practice and member-level cost and utilization data at regular intervals for all practices





CPC+ measure set


2018 eCQM changes • Remove depression remission at 12 months • Replaced by two other depression measures • Use of Imaging Studies for Low Back Pain • Few practices report Still under consideration for removal • Use of High Risk Medications in the Elderly • Updates to logic potentially permit tweaking orders that keep patients out of numerators • Concerns about rigid implementation that doesn’t address situations when meds should be ordered


Central Ohio CPC+ Practice Support • Provide individualized practice support for assigned practices in defined geographic area • Engage with The Health Collaborative CPC+ team • Practice support, learning activities, ongoing communication, tracking deliverables, requirement deadlines • Participate in CMS, BAH and Lewin learning activities, Regional Learning Network meetings, CPC+ Connect


Discussion: Thinking about the potential of this type of CPC+ work‌from the perspective of promoting value based healthcare in our community, what collaborative care coordination opportunities does CPC+ create? What challenges could we face?


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