Abhinav Shashank is the CEO and Co-Founder at Innovaccer, a big data and analytics company based out of Silicon Valley.

The role of technology in comprehensive primary care

January 27, 2017 AT 3:08 PM

Last week, I noted that CMS has launched an “upgrade” to its 3-year Comprehensive Primary Care program.  Not surprisingly, technology will play a key role in the success of the new CPC+.

Relationship with Vendors

For developing the necessary Health IT, it is required that vendors and practices work together. A vendor that supports an existing practice has to enter into a Memorandum of Understanding (MOU) with CMS and also provide their letter of support to the practice. A vendor could also be a part of the program voluntarily. Vendors won’t receive direct payments from CMS. They are expected to be a part of learning activities as mentioned in the guide by CMS.

How practices get paid in CPC+?

Comprehensive Primary Care Plus has introduced three ways by which program will be supported.

1.       Care Management Fee: On the basis of the risk level of patients (according to HCC Coding), per beneficiary per month (PBPM) stipend will be paid which should be used for staffing, technology and various training exercises under CPC+.

2.       Performance-based incentive payment: Based on the quality of care provided the practices will get paid. They will be paid prospectively by CPC+ and incentives will be given after retrospective reconciliation of the quality of care delivered and cost incurred. The incentives will depend on measures such as patient experience, clinical quality measures, and utilization measures that play an important role in driving the cost of care.

3.       Medicare Physician Fee Schedule: Practices in Track 1 will continue the fee-for-services billing and will receive money from Medicare in the similar fashion. However, Track 2 payments will be under Comprehensive Primary Care Payments, which reduces the amount paid in FFS but with an increased upfront payment.

Advantages of CPC+

There are so many things that will in better shape once CPC+ is enforced. High-risk patients will get focused proactive care, practices will be in a comfortable position to take steps that will fulfill the mental and physical needs of patients and their families, increased chances of timely follow-up and the quality of care is analyzed with the data made available and continually worked upon for improvements. With CPC+ patients get to access the preferred care with enhanced in-person hours accompanied by 24/7 access via telephone and online tools.

Role of Technology in CPC+

The success of CPC+ is directly dependent on the technological advancements and their applicability. The most important task that CPC+ will have to accomplish is improving the quality of care and for that it is imperative that appropriate data is available to assess the current quality standards. Besides this, technology will help in:

·         Tracking all the patients

·         Monitoring results

·         Planning timely interventions on the basis of risk scores.

·         Performing predictive analytics to discover cost efficient methods.

·         Designing apt planning tools.

·         Enhanced Care Coordination

Takeaways and the Road Ahead

The model has the capability to bring in force one of the most important aspects of healthcare i.e. preventive care. It drives the focus of practices towards better primary care and incentivizes practices for excelling at that.

There were only 500 practices in CPC, but CPC+ will have five times more practices in it and a lot more patients whose needs will be catered to. The sign is clear that the predecessor model has not only set the stage for improvements but also has provided us with innumerable opportunities, and we have to grab them with both hands. With CPC+, a stronger bond between technology and health care will be forged, one where doctors can use their acumen to revolutionize the healthcare with technological advancements.