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.

CPC Program Updates for 2020

Learn more:

2020 is the fourth performance year for the Ohio CPC program. The 2020 performance year will run from January 1, 2020 to December 31, 2020. Communications have started going out to participating practices. In order to receive our communications, make sure you are signed up via our listserv below.

The enrollment period for the 2021 program year will start approximately around October 1, 2020. 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.

 

Sample quarterly CPC Practice Report

How to Read Your Attribution and Payment File

Attribution Sample File

How to Read Your CPC Practice Report

How to Read Your CPC Referral Report

Sample quarterly CPC Referral Report

  • CPC Webinar: Reports, Communication, Updates and Reminders (1/23/20) Recorded Webinar
  • Provider Practice Webinar: Welcome to Ohio CPC 2020 (12/19/2019) PDF | Recorded Webinar | Q&A
  • Provider Practice Webinar: Total Cost of Care Calculations (8/30/19) PDF | Recorded Webinar
  • Payment Innovation Webinar: Program Update (8/27/19) PDF | Recorded Webinar
  • Provider Practice Webinar: Episodes of Care Metric (8/8/19) PDF | Recorded Webinar
  • Final Friday Best Practice Webinar: School-Based Health Care (6/28/19) PDF | Recorded Webinar
  • Provider Practice Webinar: CPC Referral Reports (5/9/19) PDF | Recorded Webinar
  • Provider Practice Webinar: CPC Practice and Partnership Reports (4/26/19) PDF | Recorded Webinar
  • Final Friday Best Practice Webinar: Integrating Non-Traditional Providers into Primary Care (03/29/19) PDF | Recorded Webinar
  • Final Friday Best Practice Webinar: Using Your Payment And Attribution File (02/22/19) PDF | Recorded Webinar
  • Provider Practice Webinar: Ohio’s Comprehensive Primary Care 2017 Program Outcomes (2/14/19) PDF | Recorded Webinar
  • Final Friday Best Practice Webinar: Managed Care Plan and CPC Partnering Opportunities (01/25/19) PDF | Recorded Webinar
  • CPC Attribution and Payment Files (01/17/19) PDF | Recorded Webinar

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