Revolutionizing Primary Care with Comprehensive Primary Care Plus (CPC+)

1. Comprehensive Primary Care Plus (CPC+) August 15, 2018

2. Comprehensive Primary Care Plus (CPC+) • America’s largest ever initiative to transform primary care • Medicare-led, multi-payer, medical home Advanced Alternative Payment Model (AAPM) HealthSCOPE Benefits

3. CPC Classic • Observed smaller increase in ED visits and hospitalizations than non-CPC practices • Likelihood of ED revisit within 30-days of outpatient ED decreased by 5% • Observed half of CMF covered by cost savings • Two CPC Classic regions received Shared Savings • providers shared cost savings with Medicare HealthSCOPE Benefits

4. CPC Classic CPC+ In 2017,CPC Classic became CPC+, the largest-ever initiative of its kind, is a five-year, multi-payer initiative designed to improve primary care in America. Seeks to transform primary clinics to patient-oriented medical homes. Requires physicians to comply with patient care, patient access, and health IT/medical record requirements in exchange for value-based payments and incentives. Estimates that up to 5,000 primary care practices, serving an estimated 3.5 million beneficiaries, could participate in the model. HealthSCOPE Benefits

5. Current Program: payer requirements 60+ payer partners across 18 regions Provide enhanced payments • Non-visit based care management fee (CMF) • Performance-based incentive payment • Alternative FFS payment for advanced practices Provide feedback • Quarterly data reports • Reporting on progress

6. CPC+ launched in 18 regions • Arkansas • Colorado • New Jersey • North Hudson/ Capital Region (NY) • Ohio/N. Kentucky • Oklahoma: Greater Tulsa Region • Oregon Original CPC regions continued for January 1, 2017 start: • Effective January 1, 2017, CPC+ • launched adding: • Hawaii • Michigan • Montana • Oklahoma (statewide) • Rhode Island • Tennessee • Greater Philadelphia • Greater Kansas City • On January 1, 2018, CMS added: • Louisiana • Nebraska • North Dakota • Greater Buffalo, NY

7. HealthSCOPE Benefits is the only Third Party Administrator in CPC+ • 2017: HealthSCOPE Benefits was selected as a payer partner in Arkansas • 2018: HealthSCOPE increased its CPC+ footprint and added • Michigan • Ohio/Kentucky • Oklahoma HealthSCOPE Benefits

8. What makes a CPC+ Clinic different? CPC+ doctors… CPC+ patients… Purposefully interact with a patients care team (e.g. pharmacist, behavioral health). Access to care team 24/7. Get same-day appointments. High-risk patients can even get priority appointments. Check for gaps in care and proactively fill them. Receive coordinated care between their doctor and others in the health system. Track patient health goals. Have access to alternative communication strategies (e.g. email for advice, online appointment requests and prescription refills). Provide comprehensive patient care, particularly for complex patients. Answer patient questions and verify understanding. Are surveyed for patient satisfaction. HealthSCOPE Benefits

9. CPC+ practices will transform • Track 1 practices will add services to visit-based, FFS care. • Track 2 practices will be asked to redesign visit and non-visit based care with particular focus on patients with complex needs. • National learning faculty and coaching staff assist practices in all CPC+ regions. HealthSCOPE Benefits

10. Oklahoma • Oklahoma • Statewide • 175 primary care clinics • 750 providers • Large systems (St. Johns, Utica Park…to small rural clinics) https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/index.html HealthSCOPE Benefits

11. Arkansas – W & NW providers • Arkansas • Statewide • 182 primary care clinics • 750 + providers HealthSCOPE Benefits

12. Employer Advantage Through careful plan design, employers can implement incentives that would encourage employee use of CPC+ providers, enhancing member access to: Enhanced access to after-hours care (resulting in reduced ER/Urgent Care visits). Compliance with standards of care for patients with chronic diseases (fewer ER visits and hospital admissions). Improved compliance with preventive services through proactive management of patient needs (earlier detection of illness). More efficient use of the healthcare system through coordination of care assistance (meaning reduced specialist utilization and redundant diagnostic testing). HealthSCOPE Benefits

13. Additional Resources Comprehensive Primary Care: 2016 Fast Facts: https://innovation.cms.gov/Files/x/cpci-fastfacts2016.pdf HealthSCOPE Benefits

14. Contact Rhonda Hill, MPH Rhonda.Hill@healthscopebenefits.com 27 Corporate Hill Drive Little Rock, AR 72205 HealthSCOPE Benefits