Primary care is pivotal to any health system and the healthcare industry has been laser-focused on increasing the quality and access to primary care. Over the years, it has become increasingly clear that the goals of optimizing quality, improving patient experience of care, and lowering costs can not be achieved without a strong primary care foundation.

To ensure high-quality, efficient, patient-centered care delivery, The Centers for Medicare and Medicaid Services (CMS) introduced the Comprehensive Care Plus (CPC+) initiative back in August 2016. Only recently, CMS has rolled out another opportunity for providers and payers to join CPC+, expecting 1000 more participants and change the way primary care is perceived and delivered.

How will CPC+ revolutionize primary care delivery?

CPC+ is a step up from CPC, or Comprehensive Primary Care model that CMS launched in 2012. CPC+ has extended its focus on five crucial goals:

  • Ensuring access and continuity of care.
  • Comprehensive care delivery and management.
  • Improving care coordination.
  • Enhancing patient and caregiver engagement.
  • Delivering planned care and improve population health.

Acknowledging the varying levels of experience with care delivery of practices, CMS has introduced two CPC+ tracks with different eligibility criteria and health IT requirements, running for five years. Track 1 encourages better care delivery, improvement in health outcomes and reduction in healthcare costs whereas track 2 pushes forward on delivering better care for high-need, high-risk patients. This apart, CPC+ will enhance primary care delivery in many ways:

  • CPC+ will advocate the introduction of more services that are not billable presently or don’t have a significant effect on margins- like conversations with care teams, behavioral health, etc.

  • CPC+ will bring about a change in how providers create workflows and deploy existing resources among themselves caregivers. Under the initiative, a care management fee is offered to the practices, helping them offer better control in delivering care services.

Health IT crucial to succeeding in CPC+

CPC+ has laid significant emphasis on health IT and technological support to enhance the delivery and quality of primary care across populations. The most important goal that CPC+ would achieve is implementing a data-driven primary care and ensure adherence to regulations. There are certain regulations CPC+ demands:

  • Deployment of certified electronic health record technology (CEHRT) at all participating practices that enables remote, real-time access to EHRs, reporting on clinical quality measures, and generation of quality reports.

  • Use of advanced health IT capabilities like EHR enhancements, securing patient health information for Track 2. Along with this, Track 2 participants would be expected to include risk stratification, identification of high-need patients, assessment of eCQM measures, and documentation of patient-reported outcomes.

  • Inclusion of IT certified to “Care Plan” and “Social, Behavioral and Psychological Data” criteria as identified in the CEHRT definition by the Medicare EHR Incentive initiative.

  • Submission of a letter of support from the appointed health IT vendor, expressing their will and commitment to support the practice in their initiative.

Beyond regulatory requirements

The need of health IT goes beyond just CMS regulations- health IT is crucial if practices are looking to gain reimbursements and succeed with CPC+, in more than one ways:

  • Aggregation of data and initial assessment of benchmarks.
  • Access to CPC+ measures and reporting on them.
  • Share patient-level data and attribution methodologies across the network.
  • Identification and assessment of patients with complex needs.
  • Documentation of resources and analysis of cost drivers.

Thrive in CPC+ with Datashop

Datashop, Innovaccer’s truly interoperable platform is purpose-built for delivering end-to-end value-based care. Datashop with its modular structure and AI-assisted platform offers intelligent care management, patient access, population health management, patient engagement programs, and all the health IT tools necessary for healthcare organizations to succeed with CPC+. With a primary focus on advanced care planning and top-notch quality care, Datashop has many offerings for organizations participating in CPC+:

  • Creating automated work queues: Datashop’s AI-assisted platform can replace the manual, inefficient work of sorting through volumes of clinical and financial data and creates automated work queues that assigns patients to the most suitable team of care coordinators.

  • Identifying patients with complex needs: Datashop’s big data platform deploys advanced analytics that calculates risk scores and identifies patients with high or complex needs, so that providers can learn about immediate risks and figure how to address them.

  • Intelligent care plans: Datashop can help providers document their interaction with patients, update their health status and design an intelligent care plan based on their demographic information, clinical data, episodes, and risk scores.

  • Patient access and engagement: Providers can leverage Datashop to reach out to patients, follow-up with them post discharge, ensure adherence to care plans, remind them of wellness visits, and ultimately engage and empower them to be in charge of their health.

Only recently, Innovaccer has qualified to be a trusted partner to client practices participating in CPC+ by CMS and offer solutions and analytics on all aspects of primary and timely care. Innovaccer’s Datashop can help providers gain clinical insights and the needed support for the delivery of primary care. Lastly, Innovaccer can also provide practices with the HIT letter of support during CPC+ application process.

Any practice looking to improve primary care must first define the problem it is trying to correct. More than that, it should also consider the feasibility of implementation. Improving primary care in a country that spends a hefty 17.1% of its GDP on healthcare, is not only critical but also demands an analytical and a process-based framework aimed to better the overall quality of care. CPC+ is one such initiative by CMS that brings together providers, payers and health IT together with a commitment to align payment and quality with care. Datashop Care was developed to optimize care delivery across all aspects and with CPC+, healthcare organizations can shape primary care and be the helping hands patients need.

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Abhinav Shashank is the CEO and Co-Founder at Innovaccer , one of the fastest growing big data and analytics company based out of silicon valley. Innovaccer recently raised $15.6 million Series A led by Westbridge Capital Partners.

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