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Blues Give High Marks to Latest CPC+ Expansion Despite Low Provider Participation

October 30, 2018

Article source: AIS Health,

The second round of CMS’s Comprehensive Primary Care Plus (CPC+) program generated far less interest than expected from payers and practices, but Blues plans that are participating say the program already is helping providers transform to a value-based system.

The CPC+ expansion, which launched in January with only 165 practices compared to the 1,000 primary care practices that CMS originally hoped to lure, is heavily weighted with Blues plans. In the four new CPC+ markets, almost all of the participating private payers are Blues or Blues-affiliated, including BlueCross BlueShield of Western New York, Blue Cross and Blue Shield of Louisiana, Amerigroup Louisiana, Inc., AmeriHealth Caritas Louisiana, Inc., Blue Cross and Blue Shield of Nebraska, and Blue Cross Blue Shield of North Dakota.

CPC+ is a five-year primary care medical home payment model that enlists public and private payers in selected markets to provide physicians with per-member per-month care management fees in addition to fee-for-service payments. Participating providers also must track quality measures and meet performance standards. The first round of CPC+, which kicked off in January 2017, includes 2,893 practices. CMS had hoped to expand the program to nearly a dozen regions this past January, but settled for just four when it received a tepid response for the second round. Several factors may have dampened enthusiasm, experts say.

CPC+ does not qualify as an Alternative Payment Model that would qualify providers for Medicare bonus payments. In addition, providers may be growing fatigued with multiple different payment models being tested by CMS and private payers. But participating Blues plans say they view CPC+ as a significant opportunity to advance their own primary care initiatives. CPC+ Aligns With Existing PCMHs Blue Cross Blue Shield of North Dakota, which is working with 25 practices as part of CPC+, decided to participate as a natural extension of its work on patient-centered medical homes and value-based care, says Pat Spier, medical home manager.

The program also created an opportunity for providers to obtain care management payments from Medicare, which helps to support primary care, adds Chelsey Matter, director, provider partnerships and analytics for the North Dakota Blues plan. “We went into it believing we had a level of alignment, and it has only helped us,” she says. “We’re getting great feedback from our provider community.” The plan has had a medical home program since 2008, initially focusing on people with chronic conditions such as diabetes and hypertension, Spier and Matter tell AIS Health. That program, called Blue Alliance, has evolved and now includes three tiers of providers, including a top tier that requires shared risk. More than 90% of primary care physicians participate in the medical home program, Matter says.

Likewise, the 25 practices participating in CPC+ represent a significant percentage of North Dakota practices, especially given that the federal program bars participation by federally qualified health centers and rural health clinics. “North Dakota is small — the numbers may not be great, but for us it is a higher percentage of practices,” she says. Program Helps Finance Transformation Providers know value-based care is coming, among both private insurers and Medicare, and want to prepare, Matter says. “The goal is strengthening primary care, but we’re not sure how to finance it. This [CPC+] is an avenue we were able to provide to get there.” CPC+ is a five-year program, and the North Dakota Blues plan and other second-round participants are in their first year.

“We have a lot of work to do to shift dollars into the value component from fee-for service, and to learn how much money we can shift to value without upsetting the apple cart,” she says. Other participating Blues plans also say they’re in CPC+ to help their providers implement value-based care. At BlueCross BlueShield of Western New York, the plan’s value-based reimbursement model for primary care, BestPractice, aligns closely with CPC+, says Thomas Schenk, M.D., senior vice president and chief medical officer. “The program should help us define quality outcomes and move care toward community standards.” A total of 75 practices in Western New York are participating in CPC+, Schenk tells AIS Health. “We are very early in our implementation and support for the program but are moving in the right direction."

We are just beginning to address quality metrics and measurement, so while not a challenge, it’s the next step….So far, we are on track.” Kevin Maher, vice president, health care value transformation, facility and professional reimbursement at Blue Cross and Blue Shield of Louisiana, says CPC+ can help improve quality and outcomes for Blues members.

“We know that the more patients our primary care physicians have in these value-based programs, the faster the practices transform,” Maher tells AIS Health. Joining CPC+ ‘Doubled the Resources’ The Louisiana Blues plan has 33 practices participating. “While that is fewer than we originally anticipated, we’re very pleased with the engagement we’re seeing from those 33 practices,” Maher says. “As with any new program, some practices may be taking a wait-and-see approach, while other entities made the decision to join other CMS programs.” He notes that joining the CPC+ program “doubled the resources to help these practices become more mature in these value-based programs.” Greater engagement by the participating practices is leading to faster change, Maher adds.

Contact Spier and Matter via spokesperson Andrea Dinneen at, Schenk via spokesperson Amber Ciesiulka at Ciesiulka.Amber@, and Maher via spokesperson Robin Mayhall at G by Jane Anderson