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Comprehensive Primary Care Plus

As part of Highmark Blue Cross Blue Shield of Western New York's commitment to advancing primary care, we are pleased to support the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care Plus (CPC+) Initiative. 

What is CPC+?

CPC+ is an advanced medical home model that, like our own BestPractice, seeks to improve health outcomes by reinforcing nationally accepted quality care measures. The five year program (2018-2022) involves nearly 60 practices in Erie and Niagara Counties who applies for the program and committed to transforming the way primary care is delivered. 

In recognition of primary care providers' efforts to deliver comprehensive care, CPC+ includes enhanced payments from CMS, including a care management fee and performance-based incentive payments.


How does it work?

Participating primary care practices were placed into one of two different tracks. To support this delivery of care, CPC+ includes three payment elements for both Track 1 and Track 2. 

  1. Care Management Fee (CMF) - a risk adjusted per-member, per-month (PMPM) base rate. 
  2. Performance-Based Incentive Payment - a prospective incentive payment (retrospectively reconciled) based on patient experience measures, clinical quality measures, and utilization measures. 
  3. Payment Under the Medicare Physician Fee Schedule - services are billed and paid fee-for-service (FFS) as usual. 
        - Track 1 FFS payment remains the same.
        - Track 2 FFS payment will be reduced, as these funds will be shifted into Comprehensive Primary Care Payments (CPCP), a lump-sum paid quarterly. 


Support for Participating Practices

As a payer partner in CPC+, alongside Independent Health, Highmark Blue Cross Blue Shield of Western New York is committed to supporting participating practices throughout this exciting initiative. 

For more information on CPC+, please visit the helpful resources, or contact us.