By Dinesh Sheth, Founder and CEO, Green Circle Health
Twitter: @GreenCircleH
The Centers for Medicare and Medicaid Services’ (CMS) recently announced the launch of a Comprehensive Primary Care Plus (CPC+) model to improve the quality, access and continuity of primary care, while also improving health and ensuring health care dollars are spent wisely. This addresses the comprehensiveness (as its name implies) and coordination of care management, patient and caregiver engagement, planned care and population health. The renewed initiative uses the current CPC program and the lessons learned so far to set three main goals:
- Advance care delivery and payment models to allow practices to provide more comprehensive care to meet the complex care needs of patients and improve their outcomes,
- Accommodate practices at different levels of transformation readiness through two program tracks in all 20 regions; and
- Achieve the Delivery System Reform core objectives of better care, smarter spending and healthier people in primary care.
[tweet_box design=”default” float=”none”]. @CMSGov launches new CPC+ model to improve quality, access and continuity of primary care @GreenCircleH[/tweet_box]
There are two primary paths that providers can take (each to include as many as 2,500 practices). The first targets practices that are ready to transform their care delivery by building the capabilities to deliver comprehensive primary care. The second is an advanced approach for practices poised to increase the comprehensiveness of care through enhanced health IT, improve care of patients with complex needs and inventory resources and supports to meet patients’ psychosocial needs.
The CPC+ regions will be nationwide and each will be determined by a density of payers that are interested in partnering with the new model. Participation requires physicians to do more than simply leverage existing electronic health record systems and telehealth services. In a recent webinar, the CMS stated that “practices must have experience in care delivery redesign beyond that seen in traditional primary care. This is to ensure that practices fit in the model and help achieve its aim.” The expectation is that participants in both tracks have demonstrated an ability to improve patient access to care and to support patient populations as a whole, making the use of next-generation of health IT, including remote monitoring technologies, essential to models’ and practices’ success of CPC+ benefits.
Providing enhanced care and aligning payment, quality measurement and data sharing efforts to achieve better outcomes is only possible by placing patients and their families at the center of healthcare. In transforming primary care delivery, there will be an intensified focus on strengthening engagement with patients at the practice level. In fact, the CMS explicitly stated that, as part of the requirements of the CPC+ model, practices must demonstrate existing care delivery activities that include assigning patients-to-provider panels, providing around-the-clock access for patients and supporting quality improvement activities. The quality measure set will give providers a clear list of the CPC+ requirements, some of which include:
- Controlling high blood pressure;
- Monitoring hemoglobin levels for high risk diabetes patients (greater than nine percent of hemoglobin A1c);
- Initiation and engagement of alcohol and other drug dependence treatments;
- Breast, cervical and colorectal cancer screening;
- Monitoring the use of high risk medications in the elderly;
- Documenting current medications in the medical record;
- Screening for influenza immunization.
At this point, many of these measures can be significantly enhanced by remote monitoring of patients. Aside from facilitating a greater ability to comply with the eventual CPC+ standards, remote monitoring technologies help providers manage a greater number of patients more effectively. Patients will follow their treatment protocol and stay on track with help from virtual coaches and care providers and patients that are consistently communicating with his or her physician will simply stay healthier as symptoms of illnesses, diseases and sickness will be detected before evolving into a more dangerous situation. This is the primary benefit for the patients and must be communicated effectively. As much as we discuss how practitioners need to adopt remote monitoring tools, there must be equally intense efforts to get patients’ buy-in to the model. In this effort, the very platforms that are used to monitor health are also channels of communication that are as effective at educating patients as they are at maintaining their health.
CMS recognizes that the effort to transform care delivery is a practice-level transformation and is not achievable with Medicare alone, as patients’ healthcare is paid for by many insurers. In reality, strengthening engagement among patients, providers, payers and all other participants through the use of information technology to increase access to the multi-mode universe of health care is critical to the success of the new model. The ongoing transformation from treatment to prevention begins with primary care centers and CPC+ is the right next step.