CMS Selects Ohio to Participate in High-Quality, High-Value Care Model

Primary Care Practices Must Apply by September 15

(August 10, 2016) The Centers for Medicare & Medicaid Services (CMS) opened the application period for practices to participate in the new nationwide primary care model, Comprehensive Primary Care Plus (CPC+). CPC+ is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.

Ohio is one of 14 regions selected for CPC+. The statewide Ohio region includes Northern Kentucky. Eligible practices may apply between August 1 and September 15.

CPC+ is a public-private partnership in 14 regions across the nation. CPC+ is a multi-payer model - Medicare, state Medicaid agencies, and private insurance companies partner together to support primary care practices - so CMS selected the regions based on payer interest and coverage. By aligning Medicare, Medicaid, and private insurance, CPC+ moves the health care system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes.

“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most – serving their patients’ needs when and how they choose.”

Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases achieve their health goals
  • Give patients 24-hour access to care and health information
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care

Practices may participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to allow greater flexibility in how practices deliver care. Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs.

To promote high quality and high value care, practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or have to pay back to CMS based on their performance on quality and utilization metrics. 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.

Ohio Program

Gov. John R. Kasich announced that in January 2017, Ohio will launch a comprehensive primary care (CPC) program to allow the state’s four largest private health insurance plans, along with Medicaid and Medicare, to pay for value rather than volume as part of the ongoing work to improve the health of citizens across the state.

Kasich said his Office of Health Transformation and Ohio Department of Medicaid have partnered with Ohio Medicaid’s five managed care organizations, commercial health insurance plans, and primary care practices across the state to implement a program that will allow approved primary care practices to earn value-based payments for providing high-quality care to patients.

Practices that are chosen by CMS to participate in CPC+ and who meet Ohio’s program requirement will be invited to enroll in the Ohio CPC program. Enrollment will open October 1. 


For questions about the model or application process
Schedule of Open Door Forums during the application period
Video explaining CPC+ payment innovations
Video describing CPC+ care delivery transformation
CPC+ Application

CliniSync can offer technology services to practices under the CPC+ program.

Ohio CPC Program Overview

Ohio CPC Background and Timeline

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