JBL Health Systems, LLC
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Comprehensive Primary Care Initiative (CPCI)
The Center for Medicare and Medicaid Innovation is launching the
Comprehensive Primary Care Initiative (CPCI) as a pilot in a handful of states and
regions around the country. These include statewide in Arkansas, Colorado, New
Jersey and Oregon, the Capital District-Hudson Valley region of New York, the
Cincinnati-Dayton region of Ohio, and the greater Tulsa region of Oklahoma.
Interested practices are being asked to request applications that will be issued in
June, and then up to 75 practices from each area will be accepted into the pilot.
Bonus payments through both commercial and public plans will be made to
participating practices.
In CPCI, Medicare will work with commercial and State health insurance plans and
offer bonus payments to primary care doctors who better coordinate care for
their patients. Primary care practices that choose to participate in this initiative
will be given resources to better coordinate primary care for their Medicare
patients.
Practices agree to provide comprehensive primary care that includes the
following 5 elements:
 Risk stratified care management - Identifying and developing care plans to
provide intensive services to high-risk, high-need, high-cost patients.
 Access and continuity - Providing patients with increased access and informing
care in other settings (e.g. emergency room) through access to medical
records 24/7.
 Planned care for chronic conditions and preventive care - Proactively
identifying care gaps and providing appropriate and timely preventive care.
 Patient and caregiver engagement - Establishing opportunities and systems
that engage patients and their caregivers in care plan goal setting and decision
making.
 Coordination of care across the medical neighborhood - As the first point of
contact for patients, leading care coordination across providers and healthcare
settings.
Full eligibility criteria for practice participation have not yet been released, but
initial eligibility criteria are available now:
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Page 2 of 2
Practices must have at least 150 Medicare fee-for-service beneficiaries. CMS will
be using claims data to align Medicare beneficiaries to practices and make
prospective payments on behalf of those beneficiaries to support the service
model. To be eligible for alignment, beneficiaries must be:
 Enrolled in Part A and Part B Medicare,
 Using Medicare coverage as their primary insurer,
 Not enrolled in a Part C Medicare Advantage, Medicare cost, or PACE Plan,
 Not institutionalized, and
 Not diagnosed with end-stage renal disease (ESRD).
Practitioners (physicians, nurse practitioners or physician assistants) must already
be submitting claims to Medicare using the standard Medicare Physician/Supplier
claims form (CMS-1500, formerly known as HCFA-1500) in either paper or
electronic format.
The practice may not currently be participating, or planning to participate, in any
Medicare initiatives that involve shared savings, including the Medicare Shared
Savings Program (MSSP, also known as the Medicare ACO Program), Pioneer ACO
model, or Independence at Home.
Selection criteria will favor practices that:
 Have providers who have achieved Stage 1 Meaningful Use of health
information technology (HIT) or have existing utilization of certified electronic
health record (EHR) systems.
 Have at least 60% of their revenue generated by payers participating in this
initiative. The list of participating payers in the CPC initiative will be announced
in June.
 Have started transforming their practice model and achieved either a statebased medical home designation or completed a national recognition
program.
 Have participated in practice transformation activities in the last three years.
JBL Health Systems, LLC is available to help interested practices apply to
participate in CPCI, and then to participate successfully to receive bonus
payments.
If a practice is interested in applying, they can answer a few questions and ask to
have an application sent to them at the CMMI website here.
©2012 JBL Health Systems, LLC, www.JBLHealth.com. All rights reserved.