National Rural ACO

News, commentary and opinion on the ongoing transformation of our health care systems.

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Payment Model a Success for Providers, Patients and Medicare

The Advanced Payment Model demonstration project is complete. The Model was designed to test whether pre-paying shared savings would result in higher participation in the model from independent physicians and rural providers. It also tests whether such participation will lower costs and/or improve the quality of care for Medicare Beneficiaries. The ACO Investment Model (AIM) follows the same principles as Advanced Payment but also allows providers employed by Critical Access Hospitals to participate in the program.


The average Advanced Payment ACO generated $2 million per performance year, almost twice as much savings per year as the average MSSP ACO. Advanced Payment model ACO’s also saved almost five times as much per beneficiary at $241.40 per year, vs. $58.64 per beneficiary per year for all MSSP ACO’s. The program saved the trust fund $21.5 million over three years.


For the 31 ACO’s that remained in the Advanced Payment program for three years, the average quality score increased from 90.2% to 92.9% by the third year.


Thirty-six of the one hundred new MSSP ACO’s in 2016 are ACO Investment Model (AIM) ACO’s, an updated version of the Advanced Payment model, and more than two-thirds of them are solely rural. Most AIM participants say they would not participate in the MSSP without AIM support. The 2016 AIM program increased rural participation in ACO’s five-fold.


ACO participation appears to have more impact in small and rural practices with limited experience in managing care when compared to all MSSP ACO’s. Small and rural ACO participants are likely to avoid penalties under MACRA’s quality payment program. Providing support for these practices at no net cost to the government is in the public interest.

In conclusion, the Advanced Payment model is successful in helping small practices and rural providers participate in the MSSP while improving quality and lowering per capita cost, and provides a net savings to the Medicare Trust fund. The Secretary should exercise her authority under the ACA to make the program permanently available to small and rural practices.

ALL MSSP ALL Advanced Pay
Per ACO Per Year $1,009,871 $1,975,039
Per Beneficiary Year $58.64 $241.40
Average Savings 0.58% 2.28%
Total Beneficiary Years 16,275,327 850,880
Total Savings $954,328,267 $205,404,040
Estimated Total Advanced Pay $80,684,908
Estimated Advanced Pay Repayment $38,369,312
Shared Savings Payments $1,298,712,390 $141,596,556
Net Savings (Loss) -$344,384,123 $21,491,888


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

Caravan Health / National Rural Accountable Care Consortium Sign Up More Than 10% of all Million Hearts Grantees

Austin, Texas – July 26, 2016 – Caravan Health and National Rural Accountable Care Consortium announced today that they were successful in signing up more than 10% of all Million Hearts practices, including the majority of rural practices accepted into the program.  Million Hearts is a national initiative with an ambitious goal to prevent 1 million heart attacks and strokes by 2017. According to Lynn Barr, CEO of Caravan Health, “This is another major milestone for our providers. Million Hearts is a terrific program that will reduce the number of heart attacks in at-risk patients, while paying providers well to implement the program.”

At first Caravan Health was not able to recruit providers for the program because patients that were in Million Hearts were not eligible for Chronic Care Management fees, a net loss of $400 per patient per year. After notifying the Center for Medicare and Medicaid Innovation (CMMI) of the dilemma, CMMI modified the rule to avoid exclusion of Care Management Payment, but only three days before the application deadline.

Caravan Health’s customer service team dropped what they were doing and called and emailed hundreds of practices right up to the deadline, providing them with a sample application and encouraging them to apply. “Our providers will receive an extra $16 million for participation, and thousands of heart attacks will be avoided. Everybody wins.” says Tristan Del Canto, who manages the customer service team.

The Consortium and Caravan Health have a highly successful track record in helping providers apply for value-based payments. “More than 90% of our AIM ACO applications were successful and make up more than 50% of all AIM ACO’s in the nation,” says Monica Bourgeau, Executive Director of the Consortium. “In addition, the Consortium was awarded a $31 million Transformation of Clinical Practice Initiative grant to assist providers to move into value-based payments, and we have already enabled hundreds of independent, rural and safety net primary care practices join value-based payment models.”

The number of practices that have signed up for the National Rural Accountable Care Consortium’s Practice Transformation Network is more than four times what was anticipated in the grant application. Almost half of those practices are small practices in urban settings who benefit from setting up the same simple, sustainable programs of care coordination and wellness and prevention. Practices preparing for MACRA and other advanced payment models are provided software, training and 24/7 advice nurse hotlines at no cost under the Consortium’s program. The Consortium is a 501c3 organization which contracts its transformation services to Caravan Health.


Bryan Hagar
Communications Director
Caravan Health
916 542 4583

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

CPSI and Caravan Health Announce Partnership to Help Rural, Community Providers Transition to Value-Based Care and Reimbursement

MOBILE, Ala.–Jul. 20, 2016– Healthcare technology leader CPSI (NASDAQ: CPSI) today announced a partnership dedicated to helping rural and community providers transition through new healthcare delivery and reimbursement changes that are driven by healthcare outcomes, the quality of healthcare provided and the goal of keeping people healthy. This new partnership will help rural providers who currently use the Thrive EHR or the recently acquired Healthland Centriq EHR access customized training, education and skill-building tools to incorporate more direct and personal primary care programs while increasing reimbursement and revenue.

Caravan Health, the services arm of the National Rural Accountable Care Consortium, supports rural providers and health systems to build clinical practices and infrastructure for value-based reimbursement programs.

Boyd Douglas, president and chief executive officer of CPSI, said, ³To most effectively adapt to and manage changes in value-based reimbursement, rural and community hospitals and healthcare providers need focused, coordinated assistance from their healthcare IT partner, combined with a customized training and education component. We believe this agreement with Caravan Health delivers that assistance.²

Commenting on the agreement, Lynn Barr, MPH, chief executive officer of Caravan Health, said, ³We welcome this partnership with CPSI, which, through its Thrive and Centriq product sets, is at the forefront of helping rural providers and health systems improve the measurement of quality scores and outcomes, as required under the changing reimbursement regulations.²

Douglas added, ³Our strategy and product offerings are designed specifically for rural and community care settings and their unique needs, CPSI recognizes that smaller health systems struggle with deciding how and where to begin the process of aligning the care they provide with the new value-based reimbursement models. We look forward to partnering with knowledgeable Caravan Health trainers to help our clients deliver the quality care they know works for their family, friends and neighbors – and be fairly compensated for that care.

³We are investing in our customers¹ long-term success through this partnership, which reinforces CPSI¹s commitment to the community healthcare marketplace. We have 35 years of experience helping rural and community hospitals operate more efficiently, and with this year¹s acquisition of Healthland, post-acute EHR American HealthTech, RCM Software Automation software company Rycan, and the development of new solutions focused on this market, we believe we are well positioned to further assist these providers in improving the overall health of their communities,² Douglas said.

Comprehensive Primary Care Plus (CPC+) Schedule Adjustment Allows Practices To Improve Eligibility

Austin, Texas – July 18, 2016 – The Centers for Medicare and Medicaid Services (CMS) now anticipates accepting applications for participation in the new Comprehensive Primary Care Plus (CPC+) payment model initiative on August 1, 2016, following the publication of CPC+ eligible regions. The subsequent extension of the submission deadline to September 15th gives an additional two weeks for practices to improve their eligibility for participation in the groundbreaking CPC Plus program.

CPC+ rewards patient-centered practices for providing comprehensive care services such as care coordination, wellness programs, expanded access and psychosocial support. The program significantly increases reimbursement, makes generous up-front payments available and pays for many activities that providers today perform for free.

A qualified advanced payment model designed specifically for primary care providers, CPC+ provides payment of 5% of your annual Part B billing and exempts you from MACRA participation – with no downside risk. The only catch is that most small practices don’t meet all of the eligibility requirements, closing off this important opportunity to the majority of independent primary care providers.

“If practices are missing any or all of the CPC+ eligibility requirements, Caravan Health can qualify most practices for CPC+ Track 2 in a few short weeks,” said Lynn Barr, CEO of Caravan Health. “In partnership with a federally-funded Practice Transformation Network, we provide all of the qualifying programs, training, IT, 24/7 access, and letters of support as well as line-by-line application counseling. This program is free to practices and in time for selection into CPC+.”

Caravan Health is a recognized national leader in healthcare services for primary care practices and is currently leading the successful transformation to value-based payment models for 23 of the nation’s most successful Medicare ACOs and over 17,000 providers.

For more information, go to

Bryan Hagar
Communications Director
Caravan Health
916 542 4583