Oregon is among 14 regions the federal government selected to participate in a sweeping program designed to transform the way the health care industry delivers and gets paid for primary care.
The program, called Comprehensive Primary Care Plus, is designed to steer medicine away from how it currently operates, in which providers are paid for each service they deliver, toward a system in which providers are rewarded for improving patients’ overall health. It’s the second incarnation of a program some Oregon providers have been participating in since 2012, which concludes at the end of this year, only this one will involve roughly 10 times more providers.
Like its predecessor, CPC+ will encompass all types of insurance — Medicare, Medicaid and commercial insurance — and it’s bolstered by the fact that a number of Oregon’s private insurers and Medicaid providers have signed on.
“A large portion of the state is now covered with payers who will be involved with this,” said Dr. Jim Rickards, chief medical officer for the Oregon Health Authority. “So I think under CPC+, many more patients will be able to be impacted to receive benefits through this program.”
Here’s how it works: Within the 14 regions, some of which encompass more than one state, providers will apply to one of two tracks within CPC+. Providers in the first track will get paid an average of $15 per patient per month, which they can put toward other staff or projects designed to enhance primary care. They’ll also continue to receive the same payments they’ve always received from insurers for providing services.
As for providers in the second track, the amount they’ve typically received for providing services will gradually decrease over the five years of the program, replaced with lump sums at the beginning of the year based on the number of patients they’re caring for. Like track one, they’ll also receive per patient per month payments averaging $28 in addition to $100 per patient per month payments for patients deemed to be higher risk.
Both tracks will also be eligible to receive additional payments for meeting certain performance measures, which have yet to be solidified.
The format is similar to how care is delivered through Oregon’s Medicaid program, which is divided into regional coordinated care organizations that the state pays based on their membership and performance on quality measures, such as fewer emergency room visits and more cancer screenings.
Providers must apply by Sept. 15 to be a part of CPC+, which begins next year and lasts until 2021.
Two Central Oregon practices are already participating in CPC+’s predecessor, called Comprehensive Primary Care: High Lakes Health Care, which has clinics in Bend, Redmond and Sisters, and Central Oregon Family Medicine, P.C. in Redmond.
Kathryn McDaniel, a nursing supervisor with High Lakes, said the biggest change CPC allowed High Lakes to make was creating a department of so-called nurse care managers, providers who interact with patients differently than the typical one-on-one office visits with physicians. Nurse care managers keep close tabs on patients; checking on them after every hospital visit, for example, to see whether they require a follow-up appointment or understand their medications.
“That adds an entire different layer to the primary health care service model,” she said.
The CPC program also encouraged High Lakes to organize its patients into risk categories based on their health statuses and other issues, said Becca Mataya, clinic operations manager for two of High Lakes’ Bend clinics. Based on a patient’s risk category, nurse care managers might call them every week or every three months, for example.
High Lakes also hired a behavioral health specialist through CPC in May who meets with patients before, after or outside of an office visit to remove barriers, especially mental health-related, preventing them from accessing health care, McDaniel said. For one patient, that meant enrolling him in a program through a pharmaceutical company that will allow him to receive free medication. For another, it meant helping a homeless patient find housing. In yet another case, the specialist is helping a patient who frequently visits the emergency room to get narcotics enroll in addiction treatment.
CPC also required practices to create patient-family advisory councils, which are currently in their second year at High Lakes. Council members’ suggestions have already prompted a number of changes at High Lakes, including hiring more people to answer phones, allowing Sisters patients to call that clinic directly and increasing patient surveys.
“Patient feedback was pretty pivotal in implementing those changes,” McDaniel said.
CPC allowed Central Oregon Family Medicine to transition a nurse into serving as a full-time care manager who checks in on patients who are deemed to be high risk because of conditions like diabetes and dementia. She ensures they’re taking their medications and aren’t having complications, said Dr. Mark Hughes, one of the practice’s physicians. Patients also get calls within 72 hours of a hospital stay or emergency room visit.
After a year of having the care manager, Hughes said diabetes’ patients average blood sugar levels were lowered.
Statewide, practices that participated in CPC saw an 8 percent decrease on hospital admissions between 2011 and September 2015, according to information provided by the OHA. They also saw a 0.5 percent decrease in emergency room visits and a 2.4 percent decrease in 30-day hospital readmissions.
No one should be concerned about CPC+ negatively affecting their care or access to their doctors, OHA’s Rickards said.
“Quite the opposite,” he said. “This program will dramatically improve the infrastructure of primary care clinics.”
— Reporter: 541-383-0304,