The Medical Home Model: Improving Care and Reducing Costs
Primary care is the foundation of our health care system. It is essential to better health and critical for reducing health care costs. The “medical home” model aims at reorganizing health care so that it is patient-centered and coordinates primary and specialty care, hospitals, home health care, and community services.
Comprehensive Primary Care Plus (CPC+) is a 5-year multi-payer medical home model initiative that began in January 2017 under the authority of the Center for Medicare & Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS). The model restructures primary care by introducing comprehensive care delivery requirements and an alternative payment design based on patients’ health status and quality of care.
Four Drivers of the CPC+ Model
The CPC+ model is based on four drivers. The program operates in two tracks that differ by care delivery and health IT requirements, as well as by payment structure. The four drivers are:
- Innovative payment design aimed at rewarding provider performance rather than services delivered
- Extensive use of health information technology (health IT), including electronic clinical quality measures
- Care delivery transformation, putting emphasis on five comprehensive care functions: care management, care coordination and comprehensiveness, expanded access, patient and caregiver engagement, and population health
- Continuous improvement driven by patient data on health care utilization, cost, and patient experience
CPC+ Model Scale: Partners, Practices, and Payments
At the time it was implemented, CPC+ was the nation’s largest initiative aimed at transforming primary care. It has involved Medicare and 79 public and private payer partners in 18 regions of the country and engaged 68 health IT vendors. The Medicare arm of the program has been comprised of more than 3,000 primary care practices and 14,000 practitioners, with over 2 million attributed Medicare beneficiaries. In 2020, Medicare CPC+ payments to participating practices amounted to $621,406,954.00.
There are two cohorts of participants: those who started in January 2017 (14 regions, initially 2,905 practices) and those who started in January 2018 (4 regions, initially 165 practices). Model participants include a diverse group of practices that vary in size, ownership, location, and composition of primary care practitioners.