The CMS Innovation Center has a number of advanced primary care initiatives designed to encourage a more comprehensive approach to the delivery of healthcare to communities, with the goal of reducing costs and improving outcomes.
Currently there are 4 ongoing initiatives in the category of Primary Care Transformation, with the most significant program being Comprehensive Primary Care Plus (CPC+). The program includes 2,982 primary care practices across 18 regions as of Jan 2018. It’s a unique public-private partnership that aligns incentives between 61 payers. As a result, this gives organizations more financial resources and flexibility to make investments, improve quality of care, and reduce the number of unnecessary services their patients receive.
The program is focused on 5 key areas:
- Access and Continuity
- Care Management
- Comprehensiveness and Coordination
- Patient and Caregiver Engagement
- Planned Care and Population Health
There are 3 reimbursement components of this Advanced Alternative Payment Model (APM):
- A care management fee
- Performance-based incentive payments
- Payment under the Medicare physician fee schedule
(For a quick overview of the program, check out the CPC+ fact sheet published by CMS.)
The CPC Plus model is ideally structured to allow practices to pursue innovative patient-centered services that previously would have appeared to be cost-prohibitive. This is precisely because the reimbursement model is focused on creating healthier, more engaged patients in the primary care setting- where people most benefit from proactive healthcare management.
CPC+ providers are actively connecting patients to resources in their community to improve their overall health and well-being; such as mental health services, educational nutrition programs, exercise and fitness programs, medication management services, and community support organizations that promote aging in place to name a few.
One disicpline that has potential to improve patient health and wellness is that of pharmacy. A clinical pharmacist is expertly trained to provide in-depth comprehensive medication therapy management services and can play an important role in improving patient health. Under-utilization, over-utilization, inappropriate use, non-adherence, and guideline compliance are all hot-topic medication issues that a clinical pharmacist is uniquely qualified to tackle.
Services a clinical pharmacist in primary care practice could provide include:
- drug regimen review
- comprehensive medication therapy management
- medication adherence counseling and strategies
- medication reconciliation post-discharge
Such services correlate to improving medication adherence quality measures, can decrease the rate of medication related hospitalizations, and ultimately result in up to a 12:1 return on investment. The cost of incorporating a clinical pharmacist into a primary care practice easily pays for itself.
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