Comprehensive Primary Care Plus

Oregon was selected by the Centers for Medicare and Medicaid Services (CMS) as one of 14 regions across the country to implement Comprehensive Primary Care Plus (CPC+). CMS refers to CPC+ as the "largest-ever multi-payer initiative to improve primary care in America." In January 2018, CMS opened up Round 2 of CPC+ for new CPC+ regions and additional payers in current CPC+ regions. Round 2 ran for four years, completing at the same time as CPC+ Round 1, and concluded in December 2021. Round 2 resulted in four more CPC+ regions (for a total of 18) and three more participating Oregon payers (marked with an asterisk below), for a total of 19 participating Oregon payers. The majority of participating practices outperformed the 50% prospective payment and earned additional performance-based payment. 

CPC+ was a regionally based, multi-payer advanced medical home model offering an innovative payment structure to improve health care quality and delivery. It was a five-year federal program beginning in January 2017 that brought significant Medicare dollars to Oregon.

Over 150 practices in Oregon were selected to participate in CPC+. The practices were diverse and varied by size, organizational structure, geographic location and practice type. All participating practices were required to be recognized as a Patient-Centered Primary Care Home (PCPCH) by the Oregon Health Authority (OHA).

Sixty-five practices participated in the first Comprehensive Primary Care initiative, bringing $12 million of additional funding paid directly to primary care practices. Oregon's more robust participation in CPC+ will bolster our efforts to move from fee-for-service to a system that pays for outcomes.

The Oregon CPC+ payers formed the Oregon CPC+ Payers Group and met monthly to:

• Collaborate to support sustainable primary care transformation that results in healthier patients and lower costs
• Identify and share payer and clinic best practices to achieve program care delivery and payment model goals
• Align to reduce fragmentation, seek simplification, and leverage existing resources
• Seek to understand and demonstrate the value of the model to change expectations of how primary care is funded

Oregon payers participating in CPC+

Oregon Health Authority fee-for service Medicaid

Commercial payers

• CareOregon
• Moda Health Plan, Inc.
• PacificSource
• Providence Health Plan and Providence Health Assurance
• UnitedHealthcare*

Coordinated care organizations (CCOs)

• Advanced Health
• AllCare CCO, Inc.
• Columbia Pacific CCO
• Eastern Oregon CCO
• Health Share of Oregon (not a CPC+ payer, but represented by CareOregon and Providence, participating Health Share of Oregon payer partners)
• InterCommunity Health Network*
• Jackson Care Connect
• PacificSource Central Oregon
• PacificSource Columbia Gorge
• PrimaryHealth
• Trillium CCO*
• Willamette Valley Community Health Organization
• Yamhill Community Care Organization

*Joined CPC+ for Round 2, which began January 1, 2018, and will run for four years, completing at the same time as CPC+ Round 1.

Background

• Overview of CPC+ (Centers for Medicare and Medicaid Services)

OHA fee-for-service resources

Practice enrollment in OHP fee-for-service

• Steps for CPC+ practices (tip sheet)
• Training webinars for practices:
• December 21, 2016
• February 8, 2017
  
• CPC+ patient list template
• How to become an Oregon Health Plan provider

Quality and utilization measurement

• Oregon CPC+ quality and utilization measures
• Quality measure specifications (updated at least annually by CMS)
• Utilization measures specifications:
  • Ambulatory care: emergency department utilization (CCO incentive measure)
  • Plan all-cause readmission (CCO performance measure)

Payment

• OHA Medicaid fee-for-service CPC+ payment model
  

Contact

• Payment, enrollment or contracting: Jennifer.R.Smith@oha.oregon.gov
• Policy implications or metrics: Summer.H.Boslaugh@oha.oregon.gov