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Comprehensive Primary Care Plus

Oregon was selected by the Centers for Medicare and Medicaid Services (CMS) as one of 14 regions across the country to implement Comprehensive Primary Care Plus (CPC+). CMS refers to CPC+ as the "largest-ever multi-payer initiative to improve primary care in America." CMS recently opened up Round 2 of CPC+ for new CPC+ regions and additional payers in current CPC+ regions. Round 2 will begin January 1, 2018, and run for four years, completing at the same time as CPC+ Round 1. Round 2 has resulted in four more CPC+ regions (for a total of 18) and three more participating Oregon payers (marked with an asterisk below), for a total of 19 participating Oregon payers.

CPC+ is a regionally based, multi-payer advanced medical home model offering an innovative payment structure to improve health care quality and delivery. It is a five-year federal program beginning in January 2017 that will bring significant Medicare dollars to Oregon.

Over 150 practices in Oregon have been selected to participate in CPC+. The practices are diverse and vary by size, organizational structure, geographic location and practice type. All participating practices will be required to be recognized as a Patient-Centered Primary Care Home (PCPCH) by the Oregon Health Authority (OHA).

Sixty-five practices participated in the first Comprehensive Primary Care initiative, bringing $12 million of additional funding paid directly to primary care practices. Oregon's more robust participation in CPC+ will bolster our efforts to move from fee-for-service to a system that pays for outcomes.

Oregon Payers Participating in CPC+

Oregon Health Authority Fee-For Service Medicaid

Commercial Payers

  • CareOregon
  • Moda Health Plan, Inc.
  • PacificSource
  • Providence Health Plan and Providence Health Assurance
  • UnitedHealthcare*

Coordinated Care Organizations (CCOs)

  • AllCare CCO, Inc.
  • Columbia Pacific CCO
  • Eastern Oregon CCO
  • FamilyCare Health
  • HealthShare of Oregon (not a CPC+ payer, but represented by other participating Health Share of Oregon payer partners)
  • InterCommunity Health Network*
  • Jackson Care Connect
  • PacificSource Central Oregon
  • PacificSource Columbia Gorge
  • PrimaryHealth
  • Trillium CCO*
  • Umpqua Health Alliance
  • Western Oregon Advanced Health
  • Willamette Valley Community Health Organization
  • Yamhill Community Care Organization

*Joined CPC+ for Round 2, which begins January 1, 2018, and will run for four years, completing at the same time as CPC+ Round 1.

Background

OHA Fee-for-Service Resources

Practice enrollment in OHP fee-for-service

Quality and utilization measurement

Payment

Fee-for-Service Updates

Patient List Changes - Upload All OHP Members

  • While the Oregon Health Authority will only be issuing PMPM payments for fee-for-service (FFS) members, please enroll all of your Oregon Health Plan members, regardless of if the member is FFS or enrolled in a CCO. We envision that this change will simplify your patient list creation processes. OHA will calculate two utilization measures for your practices to determine if you qualify for a Performance Incentive Payment. Given the small number of FFS members, OHA will calculate your performance based on all of your enrolled Oregon Health Plan members; however Performance Incentive Payments will be issued as a PMPM payment only for FFS members. We anticipate that incentive payments will be available starting in Q4 2017.

MMIS Provider Web Portal Update

  • Previously, we had anticipated that the provider web portal would be available for CPC+ practices to begin uploading patient lists by March 1, 2017. This has now been delayed to May 1, 2017. OHA is working diligently to craft an efficient and systematic method for your clinics to enroll members under the CPC+ program. We will continue to provide updates on how this process is coming along, and alert your practices if the timeline changes.

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