Providers

5 requirements of CPC+: Access and continuity (function 1)

January 20, 2020|

At RxLive, we work with a number of CPC+ (Comprehensive Primary Care Plus) practices as part of their comprehensive care team. We are a little over halfway through the CPC+ implementation timeline. Now is the time to review your current initiatives and determine whether they are successful or need to be tweaked.

It’s easy to get into the routine of doing the same thing over and over, but that monotony can be to the detriment of your practice, providers and patients. You’re being paid more to improve patients’ health outcomes, this should be at the forefront of every decision your practice makes.

We’re here to help. This blog post series will break down the five requirements so you can easily assess whether or not you’re meeting them. This program continues until 2021, which means we are far enough along to learn from mistakes and have adequate time to make improvements. As our series progresses, each function will be linked here so you can easily access all of them. (Link to function 2, access and continuity.) 

Primary Care First is expected to launch in 2021. CPC+ is one of the models examined when coming up with the criteria for PCF, so this series can also be worthwhile for practices exploring PCF to start thinking through implementing some of these requirements early. 

If you’re looking for a quick exercise to stimulate thoughts on if you’re maximizing your efforts to meet function 1, skip to the end for a list of questions that will help you examine how effectively your practice is meeting the requirements.

 

FUNCTION 1: Access and Continuity

From the Centers for Medicare & Medicaid Services (CMS), here’s a table detailing Track 1 requirements for function 1.

What does this mean?
Here, the key word is responsibility. 2018 Program Year 1 and 2 requirements were to ensure that over 95% of your patients were empaneled. These patients were to be assigned to a provider and care team in a deliberate way (think sensitivity to patient and family preference). It’s important for each patient to create a relationship with a provider to achieve a level of comfort when discussing personal health.

Empanelment is a cultural transformation ― you must shift your focus from caring for individual patients to managing the health of a definite population of patients. Healthcare is no longer reactive, but proactive…every established patient must receive optimal care.

The extra reimbursement provided by CPC+ should ensure that each provider has a finite number of patients. Spending more time with each one reviewing goals and objectives and thinking about proactive ways to achieve improved health should be the norm.

As their needs change with time, it’s best practice to regularly review these patient assignments and update when necessary. You need to ensure that each provider has a balanced patient load so each can provide a deeper level of care. Don’t forget to use panel data and registries to proactively contact, educate and track patients depending on their unique and evolving needs.

At this point in the process, your patients should have 24/7 access to a care team practitioner with real-time access to the EHR. Do you have a patient portal that’s truly user-friendly? Is there a staff member who’s always available to speak with a patient? These are two big things when meeting the requirement for access and continuity.

What’s the difference if you’re Track 2?

In addition to empanelment and improving patient access to care, Track 2 practices need to think bigger about alternative ways to help their patients.

For 2018 Program Year 1 and 2 requirements, this means offering/delivering (you see the strengthening of words from one to the other) an alternative to traditional office visit-based care. Not everyone will come to you, so the practice must go to them, whether it’s via telehealth (phone or video) or traveling to an alternative location (home, group homes, etc.)

By 2019 you’ve tried some ideas and have seen what works for your practice and patient population. Now in 2020, you’re continuing that model and expanding on other ideas to make delivering care even more innovative, so patients get the right care at the right time. That could mean providing telehealth for the mom with the screaming baby at home who can’t make it to the office, or going to a group home where you can see patients who have limited access to transportation.

Just make sure you aren’t sitting back and waiting for patients to come to you. You became a Track 2 practice so you could test advanced ideas for providing care.

Important questions to ask yourself from this post:

  1. Is there a member of your care team available to patients 24/7?
  2. Is it convenient for your patients to reach the care team?
  3. Do you have a patient portal?
  4. How user friendly is that patient portal?
  5. What percent of your patients are empaneled? (If you are not at 100%, examine the patients that are not to see if there is a reason.)
  6. When is the last time you reviewed patient assignment and updated patient load?

In addition, for Track 2 practices:

  1. What other innovative ways are you providing care to your patients?
  2. What percentage of your patients are you reaching through these additional avenues?

Next blog: Evaluating success with function 2, care management
So hopefully by now you’ve mastered and can document your mastery of CPC+ function 1, access and continuity. In the next blog, we’ll discuss your goals for function 2, care management, and ways to help ensure you’re effectively meeting if not exceeding this important function.

RxLive has pharmacists that work during evening hours, which could help with continuum of care. We also provide medication management via phone or video, which is a reimbursable and effective adjunct to traditional in-office visits. If you’re interested in learning more about how our services can benefit your patients, please call us at 866.234.4974.

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