Comprehensive Primary Care (CPC) Program

What is Ohio CPC?

Ohio CPC is an investment in primary care infrastructure intended to support improved population health outcomes. CPC is a patient-centered medical home program, which is a team-based care delivery model led by a primary care practice that comprehensively manages a patient’s health needs.

The goal is to empower practices to deliver the best care possible to their patients, both improving quality of care and lowering costs. Most medical costs occur outside of a primary care practice, but primary care practitioners can guide many decisions that impact those broader costs, improving cost efficiency and care quality.

CPC practices may be eligible for two payment streams in addition to existing payment arrangements with the Ohio Department of Medicaid and the Medicaid Managed Care Plans:

  • Per-member-per-month (PMPM) payment, to support activities required by the CPC program
  • Shared savings payment, to reward practices for achieving total cost of care savings

Additionally, joining the CPC program gives practices access to data and reports that provide actionable, timely information needed to make better decisions about outreach, care, and referrals.

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Practices will be able to enroll in the CPC program beginning in fall of 2016. Enrollment will be open annually each fall, during which new practices can enroll in the program. Practices only need to enroll once; enrollment will roll over from year to year. There are different eligibility requirements for practices enrolling in 2016 and for practices enrolling in 2017 onwards. Details on the eligibility requirements and enrollment process are provided below.

Payment for CPC practices may include two types of payment: (1) per-member-per-month (PMPM) payments and (2) shared savings payments. All CPC practices are eligible for PMPM payments, and some may be eligible for shared savings payments. PMPM payments and shared savings payments are distributed to CPC practices directly by ODM and the Medicaid managed care plans. Details on the definition and methodology for these two payment streams are provided below, as well as some key definitions used in both methodologies.

There are three types of requirements that practices must meet in order to receive payments through the CPC program: activity requirements, clinical quality metrics, and efficiency metrics. Practices must meet all activity requirements, 50% of applicable quality metrics, and 50% of applicable efficiency metrics in order to be eligible for payment.

Definitions and specifications all requirements are found below. Specifications include numerator and denominator requirements, exclusions, and time frame. Detailed codesheets, which outline the specific codes included in each metric, will be available to practices who are enrolled in the CPC program.

The performance period and reporting for Ohio CPC begins in January after the provider enrolls in the program. Providers receive quarterly progress reports and annual performance reports.

Sample quarterly CPC Practice Report

How to Read Your Attribution and Payment File

How to Read Your CPC Practice Report

How to Read Your CPC Referral Report

Sample quarterly CPC Referral Report

  • Provider Practice Webinar: CPC Practice Monitoring and SIM State Evaluation (9/12/17)  PDFRecorded Webinar
  • Provider Practice Webinar: Ohio CPC Referral Reports (8/08/2017) PDF │Recorded Webinar
  • Provider Practice Webinar: Ohio CPC’s approach to quality and efficiency measurement (7/11/2017) PDF │Recorded Webinar
  • Provider Practice Webinar: Attribution and Risk Tiers (6/13/2017) PDFRecorded Webinar
  • Provider Practice Webinar: Ohio CPC Reports (5/09/2017) PDF │Recorded Webinar
  • Provider Practice Webinar: Activity Requirements (4/25/2017)  PDF Recorded Webinar
  • Provider Practice Webinar: Attribution and Payment (4/06/2017)  PDF Recorded Webinar