CPC+ model saw significant investment but limited returns in 2017

Although the Comprehensive Primary Care Plus (CPC+) model saw high rates of provider participation and support from CMS , it had minimal impact on care outcomes or cost in 2017, according to the first annual report on CPC+ released April 22.

The independent report, conducted by Mathematica Policy Research, looked at the first year that CPC+ was implemented and evaluated the following performance areas:

• How CPC+ affected cost, service use, and quality-of-care outcomes
• How practices implemented CPC+
• Participation in CPC+
• Support participating practices received

Overall, the program did not have significant favorable impact on Medicare fee-for-service (FFS) beneficiaries in 2017, according to the report, which noted that was expected. The model made almost no difference on service use: outpatient emergency department visits were reduced by approximately 1% and growth in primary care ambulatory visits was slowed by approximately 1%. There was no statistically significant effect on acute hospitalizations, ambulatory visits to specialists, 30-day readmissions, or the proportion of beneficiaries who had hospice care, an advanced care plan visit, or who died, the report said.

Including enhanced CPC+ payments, the model increased expenditures by 2%–3%. However, this is similar in size to the average care management fees practices received for Medicare FFS beneficiaries.

Although the report found that participating practices received significant financial, technical, and educational support, many participants stated that they needed additional funding and more guidance to meet CPC+ requirements. In 2017, on average, a CPC+ Track 1 practice received more than $88,000 in care management fees over and above what it already received for providing care. A CPC+ Track 2 practice received $195,000 in care management fees over and above what it already received for providing care. Medicare FFS patients represented 36% of CPC+ patients, but CMS paid 76% of reported care management fee payments. This was due in part to the higher needs of Medicare FFS patients.

According to the report, participation in CPC+ was robust. In 2017, 63 payers and 2,905 primary care practices participated, representing 14 geographic regions, 13,209 primary care practitioners, and 15 million patients, including 2.2 million Medicare fee-for-service beneficiaries. The participating practices represented a diverse cross-section of size and location, with practices ranging from one to 80 primary care practitioners, located in urban, rural, and suburban areas. However, when compared to other practices, participating practices were slightly more likely to have a Patient-Centered Medical Home, have participated in a prior primary care initiative, and/or be owned by a hospital or health system. Participation remained generally stable throughout 2017, the report said.

The report notes that because the data covers only 2017, it is too early to determine the ultimate effects of CPC+.