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 DescriptionsNovember 16, 2016
    PAC In-Person Kickoff Meeting HighlightsOctober 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 3February 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 PolicyJune 13. 2017
    View the PDF
    CPC+ Payment MethodologiesFebruary 17, 2017
    View the PDF
    2017 CPC+ Implementation Guide: Guiding Principles and ReportingMay 10, 2017
    View the PDF

    For questions about the PAC, please contact Jennifer Sulkin

    Copyright © 1997-2020, The MITRE Corporation. All rights reserved. MITRE is a registered trademark of The MITRE Corporation. Material on this site may be copied and distributed with permission only.

    Log in with your credentials

    or    

    Forgot your details?

    Create Account