Ohio to reward primary care providers for holding down costs

CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model. In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models in the proposed Quality Payment Program beginning 2019. A study by the Department of Health and Human Services found this form of improper billing seems to be relatively common, since some Medicare providers are unlawfully billing enrollees after receiving payments from Medicare and Medicaid, according to the article.

The regions were selected by CMS based on payer interest and coverage.

Unterman “appears [to be] forming alliances with the Georgia Chamber of Commerce to push for a Medicaid expansion model similar to that which was implemented in the state of Arkansas called the ‘Private Option, ‘” state Rep. Jason Spencer (R-Woodbine) wrote in an op-ed for Georgia Health News on June 28. CPC+ starts in January 2017.

The original model launched in 2011 in seven regions: Arkansas, Colorado, New Jersey, New York’s Capital District-Hudson Valley region, OH and Kentucky’s Cincinnati-Dayton region, Oklahoma’s greater Tulsa region and Oregon.

The three other CPC+ payer regions are the Greater Kansas City Region in Kansas and Missouri, the North Hudson-Capital Region of NY, and the Greater Philadelphia Region of Pennsylvania.

CPC+ will operate on 2 separate tracks, with more complex cases getting their own track. “To better serve and protect taxpayers from potential wasteful spending, I am hopeful CMS heeds the advice of Congress’s non-partisan oversight agency and takes the appropriate steps to ensure it is adequately coordinating and aligning payments for our local health care providers”.

Bruce Hill, president and CEO, Buckeye Health Plan, said the insurer “shares the vision that high-quality, coordinated primary care is the foundation of good health for our members, and we are committed to working closely with our network of more than 30,000 providers, Ohio’s managed care plans, the state of OH and other partners to continue to improve the health of our members and all Ohioans”. They can receive a Medicare care management fee of $15 per beneficiary per month and a performance-based monthly payment of $2.50 per beneficiary per month. After all, to put it very bluntly, under “pure” fee-for-service payment, the incentive is to let patients go and come back again.

Medicare also recently updated its “Guide to Choosing a Hospital”, which includes a checklist of questions to ask your doctor and explains how to find the hospital that’s the right fit for you.

Arkansas participated in a predecessor program – Medicare’s Comprehensive Primary Care Initiative, which began in 2012 and will end at the end of this year – that included three other states and parts of three others.

OH is taking a major step forward in its efforts to create a national model that will reward primary care providers who do more to keep patients well and hold down the total cost of care.

“CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices”, said Patrick Conway, MD, CMS deputy administrator and chief medical officer. So far, unnamed 57 payers will take part.