CPC+ and the Clinical Pharmacist

The CMS Innovation Center has a number of advanced primary care initiatives designed to encourage a more comprehensive approach to the delivery of healthcare to communities, with the goal of reducing costs and improving outcomes.

Currently there are 4 ongoing initiatives in the category of Primary Care Transformation, with the most significant program being Comprehensive Primary Care Plus (CPC+). The program includes 2,982 primary care practices across 18 regions as of Jan 2018. It's a unique public-private partnership that aligns incentives between 61 payers. As a result, this gives organizations more financial resources and flexibility to make investments, improve quality of care, and reduce the number of unnecessary services their patients receive. 

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The program is focused on 5 key areas:

  1. Access and Continuity
  2. Care Management
  3. Comprehensiveness and Coordination
  4. Patient and Caregiver Engagement
  5. Planned Care and Population Health

There are 3 reimbursement components of this Advanced Alternative Payment Model (APM):

  1. A care management fee
  2. Performance-based incentive payments
  3. Payment under the Medicare physician fee schedule

(For a quick overview of the program, check out the CPC+ fact sheet published by CMS.)

The CPC Plus model is ideally structured to allow practices to pursue innovative patient-centered services that previously would have appeared to be cost-prohibitive. This is precisely because the reimbursement model is focused on creating healthier, more engaged patients in the primary care setting- where people most benefit from proactive healthcare management.

Happy female patient with a group of primary care providers.jpeg

CPC+ providers are actively connecting patients to resources in their community to improve their overall health and well-being; such as mental health services, educational nutrition programs, exercise and fitness programs, medication management services, and community support organizations that promote aging in place to name a few.

One disicpline that has potential to improve patient health and wellness is that of pharmacy.  A clinical pharmacist is expertly trained to provide in-depth comprehensive medication therapy management services and can play an important role in improving patient health. Under-utilization, over-utilization, inappropriate use, non-adherence, and guideline compliance are all hot-topic medication issues that a clinical pharmacist is uniquely qualified to tackle. 

Services a clinical pharmacist in primary care practice could provide include:   

  • drug regimen review
  • comprehensive medication therapy management
  • medication adherence counseling and strategies
  • medication reconciliation post-discharge

Such services correlate to improving medication adherence quality measures, can decrease the rate of medication related hospitalizations, and ultimately result in up to a 12:1 return on investment.  The cost of incorporating a clinical pharmacist into a primary care practice easily pays for itself.  

 

 You may also want to check out the following:

Should You Incorporate a Clinical Pharmacist into Your Practice?   

        

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At RxLive we offer concierge telehealth services and partner with provider organizations to improve patient health and deliver outstanding patient satisfaction, elevating the overall patient experience. For more information about how we can help follow the link below.

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Posted by Kristen

Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. She became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.