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.

What is Ohio CPC for Kids?

Practices enrolled in Ohio’s CPC program that serve Medicaid children under age 21 may also be eligible to participate in CPC for Kids. CPC for Kids is a pediatric-focused component of CPC that provides additional per-member per-month payments and opportunities for quality add-on payments in exchange for performance on additional metrics related to lead testing and immunizations, as well as additional pediatric-focused activities. A brief summary of the CPC for Kids can be found here.

CPC Program Updates for 2021

Learn more:

2021 will be the fifth performance year for the Ohio CPC program. The 2021 performance year will be from January 1, 2021 to December 31, 2021. In order to receive all our communications, make sure you are signed up via our listserv below.

The enrollment period for the 2022 program year will start approximately around October 1, 2021. All eligible practices will receive an email invitation to enroll.

 

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.

 

How to Read Your CPC Practice Report - Video NEW

Sample quarterly CPC Practice Report

Sample quarterly CPC Practice Partnership Report

How to Read Your Attribution and Payment File

Attribution Sample File

Sample quarterly CPC Member-level Practice File

The 2021 program year welcome webinar is scheduled for December 2020. Starting in January, we are hosting quarterly webinars for the 2021 CPC program year. If we determine any additional webinars are needed, they will be added to our schedule below.

The 2021 CPC webinars are scheduled from 2:30-3:30pm and are subject to change as necessary. We will continue to record webinars and post them here. Notifications of webinar topics and if a webinar needs to be cancelled will go out via our CPC listserv. Scroll down and sign up for our listserv if you have not done so yet.

For the 2021 quarterly webinars series go to https://attendee.gotowebinar.com/register/376653511970819853, to register.

For the March 25, 2021 best practice webinar go to https://attendee.gotowebinar.com/register/461690843622309133, to register.

The 2021 Schedule is:

Date Webinar
12/17/2020 CPC 2021 Program Year Welcome
01/21/2021 Patient Experience, Cultural Competency and Implicit Bias
03/25/2021 Best Practice: Integrated Behavioral Health-Prevention
04/15/2021 Specialized Recovery Services Program (SRSP) and Care Management Activity Requirements
09/30/2021 TBD
12/09/2021 TBD

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