AmeriHealth Caritas Louisiana, a Healthy Louisiana Medicaid managed care plan, has been chosen by the Centers for Medicare & Medicaid Services (CMS) to participate in Comprehensive Primary Care Plus (CPC+), the second phase of CMS’ nationwide primary care payment redesign initiative. AmeriHealth Caritas Louisiana is one of only three Louisiana health plans selected to participate in this program.
CPC+ is a five-year, multi-payer advanced medical home model. Primary care practices that participate in the program are incentivized to more effectively use data and care management protocols to drive health outcomes. The program stands to benefit AmeriHealth Caritas Louisiana members, who receive care at those practices by:
• Supporting patients with serious or chronic diseases to achieve their health goals.
• Giving patients 24-hour access to care and health information.
• Delivering preventive care.
• Engaging patients and their families in their own care.
• Working together with hospitals and other clinicians, including specialists, to provide better-coordinated care.
As a health care payer, AmeriHealth Caritas Louisiana will modify its underlying payment policies in ways that incentivize participating practices to deliver care in more patient-centered ways. In addition to performance-based incentive payments, AmeriHealth Caritas Louisiana will provide risk-adjusted care management subsidies to primary care practices that serve at least 150 AmeriHealth Caritas Louisiana members to support care coordination and quality management activities. Participating AmeriHealth Caritas Louisiana network providers will also have access to dashboards that will offer real-time data insights for practices to manage their performance.
“Our plan’s participation in the CPC+ program reflects AmeriHealth Caritas Louisiana’s mission to helping our providers transform their practices to deliver the highest level of care to our members,” said Kyle Viator, market president for AmeriHealth Caritas Louisiana. “Aligning financial incentives, giving providers actionable data, and rewarding based on quality empowers providers to focus on serving patient needs when and how they choose.”
AmeriHealth Caritas Louisiana’s participation in the CPC+ program is a continuation of the plan’s ongoing movement toward value-based health care. The health plan recently expanded its primary care provider (PCP) Quality Enhancement Program, which provides financial incentives based on of the delivery of high-quality and cost-effective care. The enhanced program now includes practices with a minimum of 50 members.
“The CPC+ program is part of a growing movement away from rewarding volume to value-based payment models that reward better results in terms of cost, quality, and outcome measures,” said Dr. Rodney Wise, chief medical officer for AmeriHealth Caritas Louisiana. “This shift puts the emphasis on ensuring the highest level of quality care for our members.”
For questions about the CPC+ model or the application process, visit the CMS website, or email CPCplus@cms.hhs.gov.