CPC+ and OCM

The CMS Innovation Center has a growing portfolio testing various payment and service delivery models that aim to achieve better care for patients, better health for our communities, and lower costs through improvement for our health care system.

Comprehensive Primary Care Plus (CPC+) is an advanced primary care medical home model designed to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the US.

CPC+ payment redesign gives practices the additional financial resources and flexibility they need to make investments that will improve quality of care and reduce the number of unnecessary services their patients receive. CPC+ provides practices with a robust learning system, as well as actionable data feedback, to guide their decision making. The care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population.



Under the Oncology Care Model (OCM), physician practices have entered into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. CMS is also partnering with commercial payers in the model. The practices participating in OCM have committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation, and national treatment guidelines for care.

OCM aims to promote whole practice transformation through the use of aligned financial incentives, including performance-based payments, to improve care coordination, appropriateness of care, and access for fee-for service (FFS) Medicare beneficiaries undergoing chemotherapy. CMS uses clinical data and quality measures as a key mechanism to verify clinical improvements, assess patient health outcomes and appropriate coordination of care, and ensure continued quality of care for Medicare beneficiaries.



Succeeding with HealthEC

HealthEC’s data integration and analytics simplify your CPC+ and OCM programs while helping you identify and address gaps in care delivery to drive better outcomes to maximize financial incentives. HealthEC has the knowledge, experience and technology to help you succeed under CPC+ and OCM in four important ways:

 

Data Aggregation

Create a unified view of clinical, financial and administrative data

Care Coordination

Promote high-priority care interventions and smarter resource utilization

Reporting Tools

Scorecards and exportable reports formatted for CPC+ and OCM reporting

Advisory Services

A range of consultative services to help you reach your CPC+ and OCM goals

BECAUSE INNOVATION MATTERS
HealthEC redefines care coordination with tools that harness the power of data to streamline workflow and optimize quality:
  • Centralization of all electronic data, both in- and out-of-network (claims, labs, prescriptions, providers, etc.)
  • Identification of gaps in care based on quality measures and clinical evidence
  • Worklists to help prioritize activities for high-risk patients
  • Dashboards with drill-down capabilities to highlight and help resolve variances