PDF CPC+ Care Delivery Requirements Crosswalk 2017-2018

CPC+ CARE DELIVERY REQUIREMENTS CROSSWALK

December 2019

2019 CPC+ Care Delivery Requirements Side-By-Side

Track 1 Requirements

Function

1 Access and Continuity

2018 Program Year 1 Requirements

2018 Program Year 2 Requirements

2019 Requirements

1.1 Achieve and maintain at least 95% 1.1 Maintain at least 95% empanelment to

1.1 Ensure patients have

empanelment to practitioner and/or

practitioner and/or care teams.

24/7 access to a care

care teams.

1.2 Ensure patients have 24/7 access to a

team practitioner with

1.2 Ensure patients have 24/7 access

care team practitioner with real-time

real-time access to the

to a care team practitioner with

access to the EHR.

EHR.

real-time access to the electronic 1.3 Measure continuity of care for empaneled 1.2 Optimize continuity of

health record (EHR).

patients by practitioners and/or care teams

care for empaneled

1.3 Organize care by practice-

in the practice.

patients while preserving

identified teams responsible for a

access.

specific, identifiable panel of

patients to optimize continuity.

Page 1 of 7

Function

2 Care Management

2018 Program Year 1 Requirements

2018 Program Year 2 Requirements

2019 Requirements

2.1 Risk stratify all empaneled

2.1 Use a two-step risk stratification process 2.1 Ensure all empaneled

patients.

for all empaneled patients, addressing

patients are risk-

2.2 Provide targeted, proactive,

medical need, behavioral diagnoses, and

stratified.

relationship-based (longitudinal)

health-related social needs:

2.2 Ensure all patients

care management to all patients

Step 1. Use an algorithm based on defined

receive timely follow-up

identified as at increased risk,

diagnoses, claims, or other electronic

contact from your

based on a defined risk

data allowing population-level

practice after ED visits

stratification process and who are

stratification; and

and hospitalizations, as

likely to benefit from intensive care

Step 2. Add the care team's perception of

clinically indicated.

management.

risk to adjust the risk stratification of

2.3 Ensure patients with

2.3 Provide short-term (episodic) care

patients, as needed.

complex needs and likely

management along with

2.2 Based on your risk stratification process,

to benefit receive

medication reconciliation to a high

provide targeted, proactive, relationship-

proactive, relationship-

and increasing percentage of

based (longitudinal) care management to

based care management.

empaneled patients who have an

all patients identified as at increased risk,

emergency department (ED) visit

and likely to benefit from intensive care

or hospital

management.

admission/discharge/transfer and 2.3 Provide short-term (episodic) care

who are likely to benefit from care

management, including medication

management.

reconciliation, to patients following hospital

2.4 Ensure patients with ED visits

admission/discharge/ transfer (including

receive a follow-up interaction

observation stays) and, as appropriate,

within one week of discharge.

following an ED discharge.

2.5 Contact at least 75% of patients 2.4 Ensure patients with ED visits receive a

who are hospitalized in target

follow-up interaction within one week of

hospital(s), within two business

discharge.

days.

2.5 Contact at least 75% of patients who were

hospitalized in target hospital(s) (including

observation stays) within two business

days.

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Function

2018 Program Year 1 Requirements

2018 Program Year 2 Requirements

2019 Requirements

3 Comprehensiveness

and Coordination

3.1 Systematically identify high-volume 3.1 Enact collaborative care agreements with 3.1 Ensure coordinated

and/or high-cost specialists serving at least two groups of specialists identified

referral management,

the patient population using

based on analysis of CMS/other payer

especially for high-

CMS/other payers' data.

reports.

frequency referral

3.2 Identify hospitals and EDs

3.2 Using CMS'/other payers' data, track

specialists and/or high-

responsible for the majority of your

timeliness of notification and information

cost specialty care.

patients' hospitalizations and ED

transfer from hospitals and EDs

3.2 Provide integrated

visits, and assess and improve

responsible for the majority of your

behavioral health care.

timeliness of notification and

patients' hospitalizations and ED visits.

information transfer using

3.3 Develop a plan for implementation of at

CMS/other payers' data.

least one option from a menu of options for

integrating behavioral health into care,

based on an assessment of practice

capability and population need.

4 Patient and Caregiver

Engagement

4.1 Convene a patient and family

4.1 Convene a PFAC at least three times in

advisory council (PFAC) at least

Program Year 2 and integrate

once in Program Year 1 and

recommendations into care and quality

integrate recommendations into

improvement activities, as appropriate.

care, as appropriate.

4.2 Implement self-management support for at

4.2 Assess practice capability and plan least three high-risk conditions.

for support of patients' self-

management.

4.1 Convene a PFAC and integrate recommendations into care and practice improvement activities.

5 Planned Care and Population Health

5.1 Use feedback reports provided by 5.1 Use feedback reports provided by

CMS/other payers at least

CMS/other payers at least quarterly on at

quarterly on at least two utilization

least two utilization measures at the

measures at the practice-level and

practice-level and practice data on at least

practice data on at least three

three electronic clinical quality measures

electronic clinical quality measures

(derived from the EHR) at both the

(eCQMs) (derived from the EHR)

practice- and panel-level to set goals to

at both practice- and panel-level to

improve population health management.

improve population health

management.

5.1 Use data to continuously improve your patients' health, experience, and quality of care, and decrease cost.

Page 3 of 7

Track 2 Requirements

Function

1 Access and Continuity

2018 Program Year 1 Requirements

2018 Program Year 2 Requirements

2019 Requirements

1.1 Achieve and maintain at least 95% 1.1 Maintain at least 95% empanelment to 1.1 Ensure patients have

empanelment to practitioner and/or

practitioner and/or care teams.

24/7 access to a care

care teams.

1.2 Ensure patients have 24/7 access to a

team practitioner with

1.2 Ensure patients have 24/7 access to a

care team practitioner with real-time

real-time access to the

care team practitioner with real-time

access to the EHR.

EHR.

access to the EHR.

1.3 Measure continuity of care for empaneled 1.2 Optimize continuity of

1.3 Organize care by practice-identified

patients by practitioners and/or care

care for empaneled

teams responsible for a specific,

teams in the practice.

patients while

identifiable panel of patients to

1.4 Regularly deliver care in at least one way

preserving access.

optimize continuity.

that is an alternative to traditional office 1.3 Use your CPC+

1.4 Regularly offer at least one alternative

visit-based care, meets the needs of your

payments to deliver

to traditional office visits to increase

patient population, and increases access

care in new ways that

access to care team and clinicians in

to the care team/practitioner, such as e-

efficiently and

a way that best meets the needs of

visits, phone visits, group visits, home

effectively meet patient

the population, such as e-visits, phone

visits, and/or alternate location visits (e.g.,

needs, leveraging the

visits, group visits, home visits,

senior centers and assisted living

skills of your care

alternate location visits (e.g., senior

facilities).

team, beyond what you

centers and assisted living facilities),

can currently

and/or expanded hours in early

accomplish in

mornings, evenings, and weekends.

traditional fee-for-

service (FFS) office

visits.

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