Private Payers News

Comprehensive Primary Care Plus Program Selects Anthem BCBS

Anthem Blue Cross and Blue Shield in Colorado will be taking part in a new CMS model called the Comprehensive Primary Care Plus initiative.

By Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has selected Anthem Blue Cross and Blue Shield in Colorado as a participant for their Comprehensive Primary Care Plus (CPC+) initiative, according to a company press release. The Comprehensive Primary Care Plus program is a five-year long initiative that uses a multi-payer model to transform the field of primary care.

Centers for Medicare & Medicaid Services

Anthem Blue Cross Blue Shield of Colorado was likely chosen to participate in the Comprehensive Primary Care Plus initiative due to the fact that the payer had already deployed a pilot program in 2012 using similar guidelines. The pilot will end by December 2016 and transitioning to the Comprehensive Primary Care Plus program will be essential to keeping their momentum in primary care transformation going. This new program incorporates both payment reform along with primary care practice alteration.

The health payer has also worked on other patient-centered and value-based care programs over the last several years through a collaboration called Anthem Togetherworks, which may provide Anthem Blue Cross and Blue Shield with a higher likelihood of success in deploying the CMS Comprehensive Primary Care Plus program.

“Anthem’s involvement in CPC+ reflects our belief in the important role that the primary care doctor can play as caregiver and navigator by providing physicians with actionable information, tools and value-based payments that reward physicians for improved quality, patient experience and affordability,” Mike Ramseier, President of Anthem Blue Cross and Blue Shield in Colorado, said in a public statement.

This health insurance company already operates with more than 2,600 providers using patient-centered, value-based care protocols. On a national scale, Anthem and affiliated health plans across 13 states have set a goal of having more than half of their healthcare payments in the form of alternative payment models by 2018 instead of the traditional fee-for-service reimbursement system.

“Anthem has demonstrated our commitment to payment innovation and provider collaboration and transformation,” Ramseier added. “Anthem’s selection as a payer participant in CPC+ presents an opportunity to collaborate with CMS, providers and other payers to continue to shift our delivery system to one that rewards quality and value.”

The Comprehensive Primary Care Plus program will require medical practices to be responsible for the total costs of care as well as higher quality. When working with payers, primary care providers will be able to improve their data exchange capabilities while also being able to share in total cost savings.

The new CMS model of care will consist of a primary care medical home approach that looks to transform healthcare delivery and reform payment between payers and providers. CMS reports that there will be two tracks that primary care practices could follow with differing healthcare delivery and payment requirements.

Since this program will be based on a multi-payer model, providers will have larger monetary resources and more flexibility to reinvent their care delivery. One goal of this program is also to reduce unnecessary healthcare spending such as through repetitive testing among multiple providers.

Improving primary care goes hand-in-hand with many of the current CMS goals around value-based care reimbursement. With better primary care, patients will get the physicals, immunizations, and screenings needed to boost preventive services, which in turn, reduce costs associated with more exacerbated medical conditions.

CMS will be further partnering with health IT vendors to further the progress of the Comprehensive Primary Care Plus initiative, based on press release statements. Any healthcare providers located in Colorado and looking to participate in the program will need to apply with CMS.

This new CMS model is based on the pilot program called the Comprehensive Primary Care initiative, which began in 2012 and will come to an end in the last days of this year. The program is meant to assist primary care providers move from fee-for-service and truly embrace value-based care reimbursement.

There are several key components of the program that primary care practices will need to incorporate such as being available to patients more broadly with 24/7 phone and electronic access, emphasizing mental health and prevention services, and putting the patient at the helm of designing medical care that meets their needs.

“Strengthening primary care is critical to an effective health care system,” Dr. Patrick Conway, CMS Deputy Administrator and Chief Medical Officer, said in a CMS press release. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our healthcare dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”

The next steps CMS will take is to decide upon which primary care providers will be participating in the program. CMS will be announcing which providers and additional payers will take part in the Comprehensive Primary Care Plus initiative by the end of this year.

 

Dig Deeper:

How Payers Should Prepare for Value-Based Reimbursement

Why Payers Should Include Consumer Engagement in Health Plans