IT in CMS' new risk-based primary care model: 7 things to know

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Earlier this month CMS announced a new primary care initiative that seeks to help practices transition to primary care. Called the Comprehensive Primary Care Plus model, the initiative focuses on five function areas to help primary care practices better integrate with other providers in the care continuum. CPC+ also places a heavy emphasis on leveraging health IT to meet these goals.

Here are seven things to know about health IT in CMS' CPC+ model.

1. Participating practices will be in one of two tracks. In both tracks, practices receive upfront incentive payments that they will either keep or repay based on performance and quality metrics.

2. Practices in both tracks are required to use certified health IT to allow remote access to the EHR, allow 24/7 access to the EHR for the care team members with real-time access, report on electronic clinical quality measures and generate quality reports.

3. However, there is a heavier emphasis in Track 2 on leveraging health IT to achieve healthcare delivery changes. "The care delivery CMS expects in Track 2 is reliant upon the use of advanced health IT capabilities that practices will need to attain through EHR enhancements or by adding or securing additional health IT services/tools," according to CMS. "Thus practices will engage their vendors to support the attainment and optimization of health IT to meet the goals and objectives of practice transformation."

4. The IT requirements pertaining specifically to Track 2 include adopting IT certified to "Care Plan" and "Social, Behavioral and Psychological Data" criteria as identified in the certified EHR technology definitions in the Medicare EHR Incentive program.

5. Track 2 participants will be expected to leverage health IT capabilities that are not always available in current platforms or are not required for ONC certification. Some of these capabilities include risk-stratifying patient populations and identifying patients with complex needs; producing and displaying eCQM results at the practice level; assessing patient's psychosocial needs; establishing a patient-focused care plan to guide care management; and documenting and tracking patient-reported outcomes.

As such, practices in this track will work with vendors to develop and optimize functions to support clinical objectives. "CMS will not prescribe how the health IT enhancement is accomplished, rather only that the health IT solution meets the CPC objective for use of the health IT by the CPC practice site team," according to CMS.

6. Furthermore, vendors of Track 2 participants will provide a "Letter of Support" to the CPC+ practice indicating they are willing to support the practice in the initiative if the practice is selected for participation. If the practice is selected for participation, the vendor will enter a memorandum of understanding with CMS outlining their commitment to support the practices in reaching the goals of the initiative. CMS will not pay vendors for their involvement in CPC+.

7. All health IT enhancements are expected to be completed within 24 months of the January 2017 program launch.

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