CPC+: Leading Patient Care Innovation, Starting in Kansas City

Greg Sweat, M.D. — March 24, 2017

The healthcare landscape is shifting– beginning with how we approach care delivery. To create a patient-focused, comprehensive healthcare experience requires an industry environment that promotes collaboration and innovation.

Blue KC is continually exploring innovative approaches to achieve high-quality, affordable healthcare for our members. We’ve also collaborated with other payers, providers and federal agencies to embrace new “Alternative Payment Models,” or APMs. These programs begin to shift the way providers are paid from the traditional fee-for-service approach to reimbursement methods that reward high quality care, more efficient healthcare spending and a seamless and simplified care experience for the patient.

This year, Blue KC kicks off its participation in the Comprehensive Primary Care Plus (CPC+) program, led by the Center for Medicare and Medicaid Innovation (CMMI), the innovation arm of the Centers for Medicare and Medicaid Services (CMS). This five-year initiative is described by CMS as “its largest-ever multi-payer initiative to transform and improve how primary care is delivered and paid for in America.” The Kansas City region is one of only 14 markets across the country chosen to participate in this program. Blue KC has the distinction of being the only payer in the Kansas City region currently taking part in this groundbreaking initiative.Cropped image of businessman video conferencing with doctor on digital tablet at desk in office

This public-private partnership aims to significantly expand patient-focused payment offerings to an estimated 20,000 primary care physicians, which will affect almost 25 million Medicare, Medicaid and privately-insured patients across the 14 markets. In the Kansas City region, there are more than 800 clinicians caring for more than 300,000 patients covered by Medicare and Blue KC, but the benefits from this transformation are expected to affect the broader community.

The multi-payer nature of the CPC+ program will significantly accelerate the level of collaboration between providers and payers. CMS purposefully designed the program to foster transparent conversations that start with patients, providers and payers in each market. Blue KC’s role in bringing the program to the Kansas City area gives us the opportunity to participate in discussions with providers as we work to improve outcomes and affordability for people in our community.

Why is primary care important?

Blue KC believes that primary care is the foundation of a strong, patient-centered, coordinated, and integrated healthcare system. Studies since the 1990s have documented the benefits of a greater emphasis on primary care – including lower costs of care, improved patient health and reduced health inequities.

We also know there is much room for improvement, starting with how primary care practices are paid. Primary care visits account for more than half of all doctor’s office visits each year in the United States, but represent just six to eight percent of national healthcare spending.1 While these providers have access to a majority of patients, they don’t always have the means to fundamentally change the way those patients are treated. The CPC+ program is designed to give providers the support and funding needed to innovate and care for their patients in ways that deliver better overall outcomes including a better care experience and improved health for the patient as well as smarter spending for all.

Innovating for the future of care

Blue KC is excited to join CMS and other payers across the country in this groundbreaking effort to benefit our members and patients across the Kansas City community. This is an important opportunity that will deliver on the promise of comprehensive primary care, bettering our community and contributing to improvements in the healthcare system locally and nationwide. Stay tuned for further updates on our progress and participation in this program in the months to come.

1 Allan H. Goroll, Robert A. Berenson, Stephen C. Schoenbaum, Laurence B. Gardner, “Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care,” Journal of General Internal Medicine, 2007, 22(3):410-415. Robert L. Phillips, Andrew Bazemore, “Primary Care and Why it Matters for US Health System Reform,” Health Affairs, 2010, 29(5):806-810.