National Rural Accountable Care Consortium Honored by CMS for Excellence in Patient Engagement

The National Rural Accountable Care Consortium (NRACC) was recognized on Aug. 3 by the Centers for Medicare and Medicaid Services (CMS) for supporting a culture of person and family engagement within their enrolled clinical practices.


This award is a strong endorsement of NRACC’s clinical-practice coaching that targets meaningful integration of patient and family voices into clinical operations, and improves patient experience by regularly capturing and discussing data on patient satisfaction.

The honor was awarded during the National Expert Panel clinical practice transformation conference in Columbia, MD, by the CMS Director of Quality Improvement Dennis Wagner, TCPI Director Robert Flemming and Dr. Paul McGannCMS chief medical officer (CMO) for Quality Improvement. The award also acknowledged and honored the leaders of an exemplary clinical practice enrolled with NRACC, Jeremy Bradley, MD and their patient representative.

NRACC, through its Practice Transformation Network, has employed innovative strategies since 2015 to engage people and families in mostly rural health care practices to improve the quality of health care. Engagement is at the heart of NRACC’s work. Specific successful techniques include distributing computer tablets to our practices to streamline patient satisfaction survey administration. NRACC also has a strong track record educating practices on a shared decision-making model between clinicians and their patients – directly supporting a patient and family centered culture.

The NRACC serves more than 8,000 clinicians nationwide through a four-year grant from the Centers for Medicare and Medicaid Innovation (CMMI). The NRACC PTN is part of the CMMI Transforming Clinical Practice Initiative (TCPI) and works with clinicians to improve the quality of patient care and clinical processes, and to prepare them for value-based healthcare payment models.

National Rural Accountable Care Consortium Approved for $3.2 Million Beyond Original Budget

The National Rural Accountable Care Consortium was approved for $3.2 million in federal funds beyond its original 2018 budget to expand its work preparing clinical practices nationwide for new reimbursement models.

The so-called carryover award from the Centers for Medicare and Medicaid Inn ovation (CMMI) targets a more personalized level of service for clients. For example, the funds will allow the organization to offer more on-site visits with clients and enable the hiring of additional practice-improvement staff.  Other service enhancements include practice-level support for quality-data extraction and interpretation of quality results.

The National Rural Accountable Care Consortium’s (NRACC) practice-transformation program is grant-funded and therefore offered at no cost to enrolled clinical practices. The Transforming Clinical Practice Initiative (TCPi) that houses the program is responsible for offering clinical practices technical support for Medicare’s Quality Payment Program/ Merit-based Incentive Payment System (MIPS).  NRACC’s staff offers enrolled practices expert consulting on MIPs that is tailored toward the practice’s specific needs and goals.

NRACC is ‘open for business,’ and actively recruiting and enrolling eligible primary and specialty care clinical practices nationwide.  To be eligible for enrollment, clinical practices must not already be participating in an a Medicare Accountable Care Organization (ACO) or the Comprehensive Primary Care Plus (CPC+) program, and they must not already be enrolled in a a competing Transforming Clinical Practice Initiative Practice Transformation Network.

NRACC’s grant-funded services include being matched with a dedicated practice-improvement coach, one-on-one monthly coaching calls, training to set up a billable care coordination service, population health software, plus proven curriculum for redesigning clinical workflows to manage population health and ensure financial sustainability.

Contact NRACC’s director of network and strategy Maeve McClellan or (916) 542-4590, for more information about enrolling your clinical practice or click here to apply now.

New Administration Sends Positive Smoke Signals About Value-Based Payments

Last week, the CMS announced a delay in publishing the final rules regarding the new mandatory cardiac and joint bundled payment programs. Significantly, the CMS did not dethe start dates of those programs, put them on hold, or cancel them all together. The new bundled payment programs will begin as scheduled, but the new administration will have a chance to make minor tweaks prior to the July 1 start date.

In spite of Secretary Price’s previous objections to mandatory CMMI programs, the green light from CMS foreshadows a continued commitment to value-based payments. A strong case can be made that the delivery system reforms instituted under the Affordable Care Act are a unique example of successful government intervention. There is compelling evidence to show that these programs have improved the quality of care for millions of people, saved hundreds of thousands of lives, and reduced spending by billions of dollars.

The pressure to reform will continue. Every provider needs to engage in value-based payment models today and begin the learning process. Currently, 30% of providers are engaged in value-based models. Provider engagement is expected to increase to 50% by 2018.  Now is the time to move forward or risk falling behind half the providers in America.

Several companies offer low-cost, supported participation in the Medicare Shared Savings Program for the third of physician groups who do not have 5,000 Medicare lives on their own. These companies include Collaborative Health Systems, Aledade, and Caravan Health.

Applications for 2018 are due to CMS on July 31st, with CMS letters of intent due by May 1st. Please reach out to us at if you would like to learn more.



Introducing the New Quality Payment Program from CMS

If your practice bills Medicare more than $30,000 a year and provides care for more than 100 Medicare patients, you will now be in the Quality Payment Program established under MACRA, The Medicare Access and CHIP Reauthorization Act of 2015.

The Quality Payment Program replaces the previous Sustainable Growth Rate formula and is broken down into a two-track framework: Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Most providers will participate through the MIPS track which will award an incentive or a payment penalty based upon performance on quality, cost, use of electronic health record technology and improvement activities. Participation in the Advanced APM path will require clinicians to take on more financial and technological risk but will yield a 5% lump-sum incentive payment.

Throughout the performance year, practices will need to record the quality of care they provide and the type of technology used. Medicare will utilize this information to give feedback about performance and determine incentive payments and adjustments.

Practices can pick their pace for the Quality Payment Program starting on January 1, 2017 with first payment reimbursements going into effect on January 1, 2019.

  • If MIPS eligible providers don’t participate at all, they can expect a 4% negative payment adjustment
  • If MIPS eligible providers submit one quality measure or one improvement activity for any point in 2017, there would be no adjustments.
  • If MIPS eligible providers submit for a partial year (a minimum of 90 days of 2017 data) they will receive either a neutral or small positive adjustment
  • If MIPS eligible providers submit for Full Year: Submit all 2017 data to Medicare they will receive a moderate positive payment adjustment

Rural Health Clinics and Federally Qualified Health Centers are exempt from reporting under MACRA. However, we encourage voluntary reporting to help those providers stay current with reporting requirements and to help prepare for advanced payment models.

The Consortium’s Practice Transformation Network prepares providers for participation in MACRA as well as in advanced payment models. This program is funded by the Transforming Clinical Practices Initiative from the Centers of Medicare and Medicaid Services (CMS).

Ready to learn more? Please visit

No Time to Read the 2200 page MACRA Final Rule? Read the AAFP’s Executive Summary Instead.

The American Academy of Family Physicians (AAFP) has created a concise and informative executive summary of the final rule addressing implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). AAFP experts have read the rule and pulled out the sections most relevant to family medicine and primary care practices.

Click here to read AAFPs executive summary of the MACRA final rule.

Comprehensive Primary Care Plus (CPC+) – Which Track is Right for You?

Sue Dietz, MPH, presents a one-hour webinar on how primary care providers can qualify for the Comprehensive Primary Care Plus (CPC+) initiative, an innovative multi-payer program offered by the Centers for Medicare & Medicaid Services (CMS) that generously compensates providers for delivering comprehensive care.


Through Sept. 15, eligible providers may apply for CPC+ Track 1 or Track 2, potentially earning $100,000 to $250,000 per year, in addition to fee-for-service. In this webinar, Ms. Barr differentiates between the two models and helps practices determine which track is best by providing an easy roadmap to meet eligibility requirements and a financial calculator to assess incentive payments.

CMS recently announced 14 geographical regions eligible for the five-year program including the states of Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Ohio, Oklahoma, Oregon, Rhode Island, and Tennessee. Additional regions are the Greater Kansas City Region of Kansas and Missouri; the North Hudson-Capital Region of New York; Northern Kentucky and the Greater Philadelphia Region in Pennsylvania.

For more information about how your practice can qualify for CPC+ in time to apply and at no cost, please go to

CY2017 Physician Fee Schedule Proposed Rule Continues Trend Towards Value-Based Payments

CMS’s 2017 Physician Fee Schedule (PFS) proposed rule offers a lot for organizations interested in transformation to celebrate. In addition to making a number of tweaks to the Shared Savings Program that demonstrate CMS leadership are listening to provider feedback, the proposed rule removes barriers for rural health care organizations to offer more preventative and consultative services.

Most importantly, CMS proposes to remove the requirement for direct supervision in rural health clinics and federally qualified health centers when providing comprehensive care management (CCM) services. When CMS first finalized CCM as a billable service, the agency determined that for rural clinics and federally qualified health centers the primary practitioner must directly supervise all aspects of the care. In the proposed rule CMS  would allow such facilities to use general supervision for services incident to CCM, just as currently allowed in a standard physician office.

CMS also simplified the conditions for practitioners operating in all settings to provide CCM services, removing cumbersome requirements for a comprehensive pre-visit as well as written agreement to receive services and share health information. They also propose important new payments for care coordination and behavioral health integration. Caravan Health will assist you in implementing these new codes once approved.

Additionally, in a significant sign that CMS is thinking about our rural members, two new telehealth codes are proposed that will allow clinicians to offer advance care planning remotely.

CMS also proposes a new program focused squarely on prevention in high risk populations. The Medicare Diabetes Prevention Program would begin January 1, 2018 and offer an opportunity for providers to partner with local community organizations or even host prevention programs themselves. CMS is seeking comments on all aspects of the new program, and we expect to see at least one more round of additional rule-making on this before the program rolls out.

Finally, CMS is proposing a few new quality measures and sun-setting others. They also propose changes to the audit process and are considering beneficiary self-assignment.

Click here to read Caravan Health’s full analysis of the proposed rule.

We will have a webinar to review the proposed rule on Tuesday, Aug. 23 at 9am PT/11am CT/12pm ET. To join, log in to, participant code 5004777. If you are unable to access the web-audio function, dial 303.248.0285.

Comments on the proposed rule will be accepted by CMS until 5pm EST September 6, 2016. A final rule is expected no later than November 1, 2016.


LeeAnn Hastings
Director of Policy & Compliance
Caravan Health

CPC+ Practice Application Open in 14 Regions

This information is provided by the Centers for Medicare and Medicaid Services

On August 1, CMS opened the application for practices to apply for Comprehensive Primary Care Plus (CPC+), the largest-ever initiative to improve primary care in America. CPC+ rewards value and quality through an innovative payment structure to support comprehensive primary care.

In CPC+, CMS has provisionally selected 57 payer partners, including commercial insurers, state Medicaid agencies, Medicaid managed care organizations, and Medicare Advantage plans in 14 regions across the nation.

Click this link to view a pdf map showing the 14 CPC+ regions and provisionally selected payers:

Want to learn more about CPC+?

  • Get your questions answered in the Practice FAQs.
  • Register for one of the 20 upcoming CPC+ Practice Open Door Forums in August and September.
  • Watch the CPC+ Video Series to get an overview of CPC+ payment innovations and care delivery transformation.
  • Submit a CPC+ application via the online portal today through 11:59pm ET on Thursday, September 15.
  • Download the CPC+ toolkit: CPC+ In Brief, CPC+ Care Delivery Transformation Brief, and CPC+ Payment Innovations Brief and Case Studies.

At CMS, we believe CPC+ is the future of primary care in America. We are pleased to partner with aligned public and private payers across the country to support up to 5,000 practices delivering the care that best meets the needs of their patients and improves health outcomes.


The CPC+ Team

Qualify for Comprehensive Primary Care Plus Program by September 15 Deadline

Comprehensive Primary Care Plus (CPC+) will pay well-deserving primary care providers an additional $100,000 to $250,000 per year, in addition to fee-for-service, for care that has previously been largely uncompensated.

Today, primary care physicians spend many hours outside the exam room, documenting patients’ history and following up on referrals, but do not get paid for activities that are not face to face. CPC+ allows doctors to spend more time during the day with patients and less time after hours on paperwork.

Track 1 and Track 2 participants are paid $180,000 to $320,000 per 1,000 patients per year for Care Management Fees, respectively, and are also eligible for $30,000 to $48,000 per year in incentive bonuses. In both tracks of the program, practices must have a care coordinator, promote wellness, use claims data, have 24/7 access, align patients with providers and report on quality.

In addition to the aforementioned $320,000, Track 2 primary care providers can get as much as 71.5% of the reimbursement previously confined to face-to-face visits, using patient-pleasing methods such as phone, email, or text advice. All procedures and routine office visits are still fully billable under the physician fee schedule, sometimes for higher rates. In either track, beginning in 2019, the practice will also receive a MACRA payment of 5% of Part B billing for five years and will be exempt from the Quality Payment Program (if the practice has fewer than 50 physicians). Participation regions and states will be selected by August 1st.

Applications are due September 15. This is a multi-payer program.

The 5,000 practices that can participate in the model may be determining the fate of primary care payments for decades to come. The Comprehensive Primary Care Initiative was the most generous program to date under CMMI, and well received by providers, but only broke even in cost savings. It’s sequel, Comprehensive Primary Care Plus promises to go even farther in both the incentives and the requirements of the program. If successful, the Secretary has the power to make the program permanent, and CPC+ pioneers can define a bright future for primary care payments.

To be eligible, practices must already have a care coordinator, promote wellness, have 24/7 access, align patients with providers and use data for care. Most small practices will not qualify without focused effort to implement the qualifying programs in a short period of time. To get assistance, please go to