Maine Left Out of CPC+ Program

Maine Left Out of CPC+ Program

Created on: Friday, August 05, 2016
Author: Peter MIchaud

Fourteen states have been chosen to participate in Comprehensive Primary Care Plus (CPC+), a national advanced primary care medical home model from the Centers for Medicare and Medicaid Services (CMS) that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation.

Maine is not one of those states.

CMS estimates that up to 5,000 primary care practices serving 3.5 million beneficiaries could participate in the model. The five-year program, beginning in 2017, is designed to give practices greater financial resources and flexibility to make appropriate investments to improve the quality and efficiency of care and reduce unnecessary health care utilization. According to CMS, it is a medical home model that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.

Building on the Comprehensive Primary Care initiative that launched in late 2012, CPC+ will benefit patients by helping primary care practices:

  • Support patients with serious or chronic diseases achieve their health goals
  • Give patients 24-hour access to care and health information
  • Deliver preventive care
  • Engage patients and their families in their own care
  • Work together with hospitals and other clinicians, including specialists, to provide better-coordinated care


Three health insurers, Anthem, Harvard Pilgrim and Community Health Options, applied to participate in the program through primary care practices in Maine. In response to CMS's invitation to participate in the program, Maine DHHS Commissioner Mary Mayhew wrote to CMS, "[W]e are somewhat perplexed by a request for a state Medicaid program to apply to Medicare for participation in a value-based payment model for Medicare physicians." She cited Maine's establishment of primary care and behavioral health homes and the MaineCare Accountable Community initiative as the major reasons for apparently declining to participate in the new initiative. Commissioner Mayhew went on to say, "We believe, however, that flexibility is a critical element to retain so that our initiatives are responsive to Maine's healthcare goals and our delivery system reforms. ...I am hopeful that Medicare's alignment with Maine's direction can be achieved quickly to accelerate delivery system transformation."

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