Welcome to the Primary Care Payer Resource Bank!
Chair
Charlie Fazio, MD
Senior Vice President and Health Plan Medical Director for HealthPartners
The Health Care Payment Learning and Action Network (LAN) launched the Primary Care Payer Action Collaborative (PAC) in October 2016 as a forum for public and private payers in Comprehensive Primary Care Plus (CPC+) to work together across regions on the shared goal of improving primary care.
Prior to August 2017, the PAC’s work followed two participant-driven tracks:
- Track 1, Defining and Assessing Regional Success in CPC+; and
- Track 2, Operationalizing CPC+ Data Distribution and Aligning Quality Measure Sets and Reporting.
Since August 2017, the PAC’s focus consists of closely supporting CPC+ payers as they implement alternatives to fee-for-service payment specifically in “CPC+ Track 2.”
Documents
This is a repository of materials from PAC virtual collaborative sessions and the PAC’s work in general, including slide presentations, meeting highlights, and other payer resources. The materials are organized by focus areas of the PAC with a separate section for CMS resources on CPC+.
PAC Learning Labs on Alternatives to FFS Payment in CPC+ Track 2
Learning Labs on Alternatives to FFS Payment in CPC+ Track 2
This section includes an overview of the PAC and materials from each virtual meeting beginning in August 2017, when the PAC tailored learning lab content and discussions to support payers as they operationalize alternatives to fee-for-service payment specifically in “CPC+ Track 2.”
| In-Person Meeting At this in-person meeting in Baltimore, MD, CPC+ payers and conveners had the opportunity to discuss opportunities and challenges related to implementation of the alternative to FFS payment for CPC+ Track 2 and examine progress across regions. | May 7, 2018 |
| Meeting Notes | |
| PAC Session 10: Claims Processing for the Alternative to FFS Payment: Practice Engagement This learning lab provides a high-level exploration of claims processing workflows and how systems are modified to enable alternative to fee-for-services (FFS) with perspectives from CMS, CareOregon, Blue Cross Blue Shield (BCBS) of Louisiana (LA), and Anthem. | April 18, 2018 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 9: Aligning on CPC+ Quality Measurement from a Medicaid Perspective This learning lab explores the ways in which CPC+ participating state Medicaid agencies have implemented quality measurement approaches with CPC+ practices. This includes how agencies have approached alignment with Medicare and across payers and how/if they are adjusting measures to address key Medicaid populations that may not be captured in Medicare measures. | April 11, 2018 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 8: Designing Payment to Support Advanced Team-based Care at the Practice Site This learning lab explores the transition from a predominantly fee for service payment environment to one substantially based on population payment, including perspectives from a primary care practice and a payer. | March 12, 2018 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 7: Constructing the Alternative-to-Fee for Service Payment This learning lab continues to build a deeper understanding of payer operations relating to CPC+ Track 2 Alternative to fee-for-service (FFS) payment. It also continues to provide an overview of Capital District Physicians’ Health Plan (CDPHP)’s Enhanced Primary Care model, addressing specific aspects of constructing this alternative to fee-for-service payment. | February 28, 2018 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 6: Risk Adjustment and Year-End Reconciliation This learning lab helps build a deeper understanding of payer operations relating to CPC+ Track 2 Alternative to FFS Payment. It also provides an overview of Independent Health’s Primary Value Model, with a specific emphasis on risk adjustment. | February 07, 2018 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 5: Implementing Primary Care Population-based Payments in Medicaid This learning lab is specific to Medicaid considerations, including approaches to aligning Medicaid payment models with CPC+ Track 2 and identifying related open questions for potential further discussion by the PAC. | November 14, 2017 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 4: Implementation: Practice Engagement This learning lab continues the discussion on implementation issues, including timing considerations for model roll-out, then pivots to practice engagement and strategies to support providers’ transition to a new model of care. | October 10, 2017 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 3: Implementation This learning lab defines key implementation steps in developing any alternative to FFS payment for primary care practices: calculating payments, setting minimum volume thresholds, determining risk adjustment and financial reconciliation policies, and other essential tasks. Participants identify challenges and share solutions for each step in the process. | September 28, 2017 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 2: Design Work Flow This learning lab discusses initial design decisions in developing any alternative to FFS payment for primary care practices, ranging from which lines of business to include in the model, to handling patient attribution. Participants identify challenges and share solutions for each step in the process. | September 14, 2017 |
| Live Poll Results | Highlights | Slides | |
| PAC Session 1: Introduction to Designing and Implementing Alternatives to FFS in CPC+ Track 2 This kick-off webinar outlines PAC objectives and serves as a preview of four upcoming “learning labs” on key payment design and implementation topics. As part of this interactive session, members of the CMS CPC+ team outline key principles and features of the CPC+ model and address participant questions. | August 29, 2017 |
| Live Poll Results | Highlights | Slides | |
| PAC Overview | |
| Overview |
General
These documents provide a high-level overview of the evolving work of the PAC, including its scope and objectives.
| PAC Work Track Descriptions | November 16, 2016 |
| PAC In-Person Kickoff Meeting Highlights | October 26, 2016 |
Track 1
Defining and Assessing Regional CPC+ Success
This section includes available materials from each virtual meeting of the PAC’s Track 1, which focused on helping payers develop a vision for regional success and practice transformation in CPC+. Track 1 meetings took place from December 2016 through March 2017.
| PAC Track 1 (Vision of Success) Meeting 1 | December 7, 2016 |
| Highlights | Slides | |
| PAC Track 1 (Vision of Success) Meeting 2 | January 20, 2017 |
| Highlights | Slides | Transcript | Recording | |
| PAC Track 1 (Vision of Success) Meeting 3 | February 17, 2017 |
| Highlights | Slides | Transcript | Recording | |
| PAC Track 1 (Vision of Success) Meeting 4 | March 10, 2017 |
| Highlights | Slides |
Track 2
Operationalizing CPC+ Data Distribution and Aligning Quality Measure Sets and Reporting
This section includes available materials from each virtual meeting of the PAC’s Track 2, in which payers shared their challenges and strategies related to data management in CPC+. Track 2 meetings took place from December 2016 through February 2017.
| PAC Track 2 (Data & Quality) Meeting 1 | December 12, 2016 |
| Highlights | Slides | |
| PAC Track 2 (Data & Quality) Meeting 2 | January 30, 2017 |
| Highlights | Slides | Transcript | Interview Highlights | Recording | |
| PAC Track 2 (Data & Quality) Meeting 3 | February 28, 2017 |
| Highlights | Slides | Transcript | Recording |
CMS CPC+ Resources
This section contains and links to CMS materials about CPC+ that participating payers may find useful.
| CPC+ Frequently Asked Questions: Payment Policy | June 13. 2017 |
| View the PDF | |
| CPC+ Payment Methodologies | February 17, 2017 |
| View the PDF | |
| 2017 CPC+ Implementation Guide: Guiding Principles and Reporting | May 10, 2017 |
| View the PDF |
For questions about the PAC, please contact Jennifer Sulkin
Payers | 
Providers
Purchasers
Community Organizations
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
