This summer, payers and providers will have the opportunity to apply for a new primary care initiative launched by the Centers for Medicare and Medicaid Services. Called the Comprehensive Primary Care Plus model, the effort is intended to improve primary care in the U.S. by increasing services and bundling payments.
CMS says the program will move physicians from the “one-size-fits-all, fee-for-service” healthcare system into one that is more comprehensive and patient-centered. The two-track effort generally centers around payment reform, and physicians in both tracks will receive monthly care management fees and upfront incentive payments. In track one, providers will also be paid the regular fee-for-service payments, and in track two, physicians will get a hybrid of fee-for-service and upfront comprehensive payments. The incentive payments will either be paid back or kept based on performance.
The idea is that the care management and incentive payments will motivate doctors to better support and engage patients, deliver preventive care and coordinate with other providers. These are important goals, but it is not clear whether the new program will be successful in achieving them. Here are three key questions for the program, the answers to which will determine the transformative ability of the CMS effort.
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