If you run, work at, or invest in primary care in Georgia — or you are trying to understand how the modern Medicare primary care medical home payment model came to be — there is a CMS Innovation Center model that defined the modern foundation for advanced primary care, even though Georgia was excluded from direct participation. That model is Comprehensive Primary Care Plus (CPC+).
CPC+ was the CMS Innovation Center's foundational voluntary multi-payer advanced primary care medical home model — the direct historical predecessor to Primary Care First (PCF, January 1, 2021 – December 31, 2026) and Making Care Primary (MCP, July 1, 2024 – December 31, 2034). CPC+ ran from January 1, 2017 through December 31, 2021 as a five-year voluntary performance period that enrolled approximately 3,000 primary care practices across 18 selected Cohort 1 regions in 14 states (plus an additional 14 regions in Cohort 2 starting January 1, 2018) with more than 70 multi-payer partners including state Medicaid agencies and commercial insurers. CPC+ represented the most ambitious multi-payer primary care medical home transformation in U.S. history at the time and produced billions of dollars in care-transformation investments — funded electronic health record optimization, hired thousands of care managers, integrated behavioral health into primary care, deployed patient-reported outcomes systems, and built population health analytics infrastructure across U.S. primary care.
The critical fact for Georgia: Georgia was NOT a selected CPC+ region. In neither Cohort 1 (launched January 1, 2017) nor Cohort 2 (added January 1, 2018) did CMS include Georgia. Georgia primary care practices could not directly participate in CPC+. Tennessee, however, was selected in Cohort 1 — meaning border-region Georgia practices could observe CPC+ closely, and major Georgia primary care leaders, including FQHC networks, Aledade Georgia, Privia Health Georgia, and Atlanta-area integrated systems, tracked CPC+ as the leading edge of federal primary care transformation policy. When PCF launched in 2021, Georgia was a selected region — and many Georgia primary care practices that had observed CPC+ lessons during 2017-2021 transitioned directly into PCF.
This guide walks Georgia primary care practice leaders, FQHC administrators, MSO and ACO operators, and Medicare beneficiaries through the complete CPC+ history: the statutory foundation, the five-year performance period, the two tracks, the 18 Cohort 1 + 14 Cohort 2 regions, the three payment components, the five Comprehensive Primary Care Functions, the multi-payer alignment with 70+ partners, the Advanced APM treatment for Track 2, and the lessons CPC+ taught CMS that shaped PCF and MCP. We also examine what Georgia primary care leaders learned by observing CPC+ even without direct participation.
What CPC+ was: the statutory and regulatory foundation
CPC+ rested on a five-layer statutory and regulatory stack:
Section 1115A of the Social Security Act (42 U.S.C. § 1315a) — the CMMI statutory framework — gives the Secretary of HHS authority to test innovative payment and service-delivery models. Added by Section 3021 of the Patient Protection and Affordable Care Act (Public Law 111-148, March 23, 2010), Section 1115A is what enabled CMS to launch CPC+ as a voluntary multi-payer demonstration without going back to Congress. CPC+ was one of the largest Section 1115A primary care demonstrations.
The CPC+ Final Notice and Request for Applications (April 11, 2016) defined CPC+ as a voluntary five-year multi-payer advanced primary care medical home model with two tracks, three payment components, five Comprehensive Primary Care Functions, mandatory quality reporting, and Advanced APM eligibility for Track 2. Practice and payer applications were due in 2016; the five-year performance period began January 1, 2017.
CPC Classic predecessor (October 1, 2012 – December 31, 2016) was the original Comprehensive Primary Care initiative — a four-year-three-month voluntary multi-payer model in 7 regions with ~500 practices. CPC Classic produced mixed but encouraging results, demonstrating that multi-payer primary care medical home transformation was operationally feasible. CPC+ scaled and refined the CPC Classic design.
Section 1833(z) of the Social Security Act — added by MACRA 2015 (Public Law 114-10, April 16, 2015), Title I, Section 101 — established the Advanced APM framework. CPC+ Track 2 qualified as Advanced APM. Track 1 did NOT qualify.
Multi-payer alignment infrastructure. CPC+ was structurally multi-payer from inception: practices participating in CPC+ received aligned payments not just from Medicare but from state Medicaid programs (where the state Medicaid agency joined CPC+) and from major commercial insurers in the region (where commercial payers signed CPC+ multi-payer agreements). More than 70 commercial and Medicaid payers participated.
When CPC+ ran: performance period
CPC+ had a five-year performance period:
- Performance Year 1 (PY1): January 1, 2017 – December 31, 2017
- Performance Year 2 (PY2): January 1, 2018 – December 31, 2018 (Cohort 2 launched)
- Performance Year 3 (PY3): January 1, 2019 – December 31, 2019
- Performance Year 4 (PY4): January 1, 2020 – December 31, 2020 (COVID-19 onset)
- Performance Year 5 (PY5): January 1, 2021 – December 31, 2021 (final)
Cohort 1 practices participated in all five PYs. Cohort 2 practices, which joined effective January 1, 2018, participated in PY2 through PY5 (four years).
The CPC+ model ended December 31, 2021. PCF launched January 1, 2021, providing a one-year overlap during which some CPC+ practices transitioned to PCF.
Who participated: the ~3,000-practice cohort across 18 + 14 regions
CPC+ enrolled approximately 3,000 primary care practices across 18 Cohort 1 regions (launched January 1, 2017) and 14 Cohort 2 regions (added January 1, 2018).
Cohort 1 selected regions (January 1, 2017)
- Arkansas (statewide)
- Colorado (statewide)
- Hawaii (statewide)
- Kansas and Missouri (Kansas City metropolitan region)
- Michigan (statewide)
- Montana (statewide)
- New Jersey (statewide)
- New York (North Hudson-Capital Region)
- Ohio and Kentucky (statewide Ohio; Northern Kentucky)
- Oklahoma (statewide)
- Oregon (statewide)
- Pennsylvania (Greater Philadelphia)
- Rhode Island (statewide)
- Tennessee (statewide)
Cohort 2 selected regions (January 1, 2018 — added)
- Louisiana (statewide)
- Maine (statewide)
- Additional Michigan regions
- Nebraska (statewide)
- North Dakota (statewide)
- Greater Buffalo Region (New York)
- Greater Kansas City Region (added depth)
CMS selected regions based on:
- Existing multi-payer primary care infrastructure
- State Medicaid agency commitment
- Commercial payer participation willingness
- Geographic diversity
- Primary care transformation maturity
Georgia was NOT selected in either cohort. This was consequential: Georgia primary care practices could not directly participate in what was at the time the most generous federal primary care payment model.
When PCF launched January 1, 2021, Georgia WAS selected, allowing Georgia primary care practices to participate in CPC+'s successor. Many Georgia primary care leaders' observation of CPC+ during 2017-2020 directly informed their PCF participation decisions in 2021-2026.
The two tracks: Track 1 and Track 2
CPC+ structured participation in two tracks:
Track 1 (Foundational Advanced Primary Care)
- For practices building advanced primary care capabilities
- Care Management Fee (CMF): typically $15 PBPM
- Performance-Based Incentive Payment (PBIP): up to $2 PBPM
- Standard fee-for-service for primary care services (no prospective payment)
- Required investment in five Comprehensive Primary Care Functions
- NOT Advanced APM — Track 1 did not qualify under Section 1833(z) SSA
- Practice physicians remained in MIPS
Track 2 (Comprehensive Advanced Primary Care)
- For practices with greater capabilities and willingness to assume risk
- Care Management Fee (CMF): higher rate, typically $28 PBPM
- Performance-Based Incentive Payment (PBIP): higher rate, up to $4 PBPM
- Comprehensive Primary Care Payment (CPCP): partial prospective payment, replacing portion of E&M fee-for-service
- CPCP started at 10% and increased to 65% by PY5 for some Track 2 practices
- Required deeper investment in five Functions
- QUALIFIED AS ADVANCED APM under Section 1833(z) SSA
- Practice physicians could become QPs, exempt from MIPS, earn 5% APM incentive
The two-track structure allowed practices new to value-based payment to enter at Track 1 and graduate to Track 2 as capabilities matured. Practices selected their track at participation, and CMS supervised track movements over the model lifespan.
The three payment components
CPC+ practices received three types of Medicare payment beyond standard fee-for-service:
1. Care Management Fee (CMF)
- Per-beneficiary-per-month (PBPM) payment
- Risk-adjusted by HCC-derived complexity tiers
- Higher PBPM for medically complex patients
- Funded care management infrastructure (care managers, behavioral health integration, population health analytics)
- Track 1: ~$15 PBPM base; Track 2: ~$28 PBPM base
- Risk-adjusted tiers ranged from ~$9 to $100 PBPM for very complex patients
2. Performance-Based Incentive Payment (PBIP)
- Annual at-risk payment
- Track 1: up to $2 PBPM at risk
- Track 2: up to $4 PBPM at risk
- Earned based on quality and utilization measures
- Paid prospectively then reconciled annually
- Practices keep at-risk amount if performance meets thresholds; retain only portion if performance lower
3. Comprehensive Primary Care Payment (CPCP) — Track 2 only
- Partial prospective payment replacing portion of primary care E&M fee-for-service
- Started at 10% replacement in PY1, increased to 65% for some Track 2 practices by PY5
- Provided prospective cash flow rather than visit-by-visit billing
- Mathematically equivalent to capitation for the percentage replaced
- Required Track 2 practices to commit to prospective payment model
The three payment components together gave Track 2 practices materially different payment economics than fee-for-service: substantial PBPM care management revenue, at-risk performance incentive, and partial prospective payment replacing fee-for-service E&M.
The five Comprehensive Primary Care Functions
CPC+ required participating practices to invest in and demonstrate five Comprehensive Primary Care Functions:
Function 1: Access and Continuity
- 24/7 patient access to care team
- Continuity with named provider
- Same-day access for acute needs
- Patient portal and electronic communication
- Care management between visits
Function 2: Care Management
- Risk-stratified care management
- Dedicated care managers for high-risk patients
- Care plans for patients with chronic conditions
- Transitions of care management (hospital discharge, ED follow-up)
- Self-management support
Function 3: Comprehensiveness and Coordination
- Comprehensive scope of services
- Integration of behavioral health
- Coordination with specialists, hospitals, ancillary services
- Closed-loop referrals
- Care plans shared across providers
Function 4: Patient and Caregiver Engagement
- Patient advisory councils
- Shared decision-making tools
- Patient-reported outcomes
- Health literacy resources
- Family caregiver inclusion
Function 5: Planned Care and Population Health
- Population health analytics
- Risk stratification
- Quality measurement and reporting
- Continuous quality improvement
- Health equity initiatives
Practices demonstrated their investment in the five Functions through Annual Practice Reports, quality measure submissions, and CMS site visits. The Functions framework explicitly drew from the NCQA Patient-Centered Medical Home (PCMH) recognition program but was operationalized with CPC+'s payment model.
Quality measures and reporting
CPC+ required practices to report on a substantial set of quality measures:
- Clinical quality measures: A1C control, BP control, depression screening, colorectal cancer screening, tobacco intervention, cardiovascular risk reduction
- Utilization measures: Total Cost of Care, hospitalizations, ED visits, readmissions
- Patient experience: CAHPS-PCMH (modified)
- Process measures: Care management workflow documentation, behavioral health integration, advance care planning
- Patient-reported outcomes: Functional status, symptom burden, quality of life
These measures fed into PBIP reconciliation, quality reports to multi-payer partners, and CMMI evaluation.
Multi-payer alignment: 70+ commercial and Medicaid payers
A distinguishing feature of CPC+ was multi-payer alignment. CMS required that each selected region demonstrate substantial commercial and Medicaid payer participation alongside Medicare. More than 70 commercial insurers and state Medicaid agencies signed multi-payer alignment agreements across the 18 + 14 regions.
Multi-payer alignment meant:
- CMF payments came from multiple payers, not just Medicare
- Quality measure submissions used aligned measure sets
- Care management infrastructure served patients across all payers
- Practice transformation investments had coherent ROI across patient panels
For practices in selected regions, multi-payer alignment was often the difference between CPC+ being economically rational vs. only marginally so. CMF payments from a state Medicaid agency, two large commercial insurers, and Medicare combined gave practices substantial cash flow for care management investment.
For Georgia, multi-payer alignment didn't apply directly (Georgia not selected). But the principle informed later Georgia Medicaid PCMH program design and Georgia commercial primary care contracting.
Advanced APM status: Track 2 only
CPC+ Track 2 qualified as Advanced APM under Section 1833(z) SSA. Practices in Track 2 could have physicians become Qualifying APM Participants (QPs):
- Exempt from MIPS for the corresponding year
- Historically receive 5% APM incentive payment on Part B professional services
- Subject to QP thresholds (patient or payment)
The Track 1 did NOT qualify. Track 1 practices remained in MIPS or reported via APM Performance Pathway (APP) if eligible through other arrangements.
The Track 1 / Track 2 design reflected CMS's view at the time that primary care practices new to value-based payment needed a transition pathway before assuming Advanced APM-level risk. This was the design ancestor of MCP's three-track glide path.
What CPC+ taught CMS: lessons that shaped PCF and MCP
CPC+ produced billions in care-transformation investments and substantial clinical and operational improvements. But the formal CMMI evaluation found mixed savings results — savings in some regions and PYs, losses in others, and no statistically significant net Medicare savings overall.
CMS's analytic conclusions shaped both PCF and MCP:
Lessons that shaped PCF (2021-2026)
- Greater prospective payment is needed — CPC+ Track 2 CPCP went up to 65% replacement; PCF made primary care more prospectively paid through Total Primary Care Payment (TPCP)
- Simpler payment structure — PCF reduced to one payment per beneficiary (TPCP = Population-Based Payment + Flat Primary Care Visit Fee + Performance-Based Adjustment) vs. CPC+'s three components
- More immediate risk — PCF placed practices in payment tiers based on patient complexity from day one, no Track 1 / Track 2 glide path
- Broader regional eligibility — PCF opened to 26 regions including Georgia (vs CPC+ 18 + 14 = 32 regions but Georgia excluded)
- All-practice Advanced APM — PCF qualified all participants as Advanced APM (vs CPC+ Track 2 only)
Lessons that shaped MCP (2024-2034)
- Longer performance period — CPC+ at 5 years was arguably too short for mature transformation; MCP runs 10.5 years
- Upfront infrastructure investment — CPC+ had no upfront capital grant; MCP added Upfront Infrastructure Payment in Year 1
- Glide path restoration with three tracks — MCP brought back glide path structure (Track 1 no risk → Track 3 prospective PBP) that PCF removed but with no upside-only on-ramp because the glide path provides capability building rather than risk avoidance
- Deeper multi-payer alignment — MCP's eight selected states have state Medicaid commitments more rigorous than CPC+
- Mandatory Health Equity Plan — CPC+ had no equity requirement; MCP requires it
- ADI data collection — MCP requires beneficiary-level ADI; CPC+ did not
Coordination with concurrent programs (historical, 2017-2021)
MSSP / Pioneer ACOs
- CPC+ practices in MSSP ACOs had aligned but separate participation
- Beneficiaries attributed to MSSP through CPC+ practices counted for MSSP reconciliation
- Practices could earn both CPC+ payments and MSSP shared savings
- Specific coordination rules in CPC+ participation agreement
NCQA PCMH recognition
- Many CPC+ practices already held NCQA PCMH recognition
- CPC+ Functions framework drew from NCQA PCMH standards
- Practices could leverage PCMH infrastructure for CPC+ requirements
MIPS / Advanced APM
- Track 2 QPs exempt from MIPS
- Track 1 practices in MIPS or APP
State Medicaid PCMH programs
- Where state Medicaid joined CPC+, state PCMH programs aligned with CPC+
- Practices received CPC+ payments from Medicaid alongside Medicare
Why CPC+ matters for Georgia even though Georgia was not selected
Georgia was not a selected CPC+ region. But CPC+ still matters for Georgia for several reasons:
1. Tennessee as a selected region
Tennessee IS a CPC+ selected region (statewide in Cohort 1). Many Georgia primary care leaders, FQHC networks, and integrated systems collaborate with Tennessee counterparts, attend joint conferences, and learn from cross-border lessons. Border-region practices in northern Georgia near the Tennessee line had particular visibility.
2. Georgia primary care leaders observed CPC+ during 2017-2021
While Georgia primary care practices could not participate, Georgia primary care leaders watched CPC+ as the leading edge of federal primary care policy. Lessons informed Georgia Medicaid PCMH program design, integrated system primary care strategy at Wellstar/Emory/Piedmont/Northside, and value-based payment infrastructure investments at Aledade Georgia and Privia Health Georgia.
3. CPC+ shaped PCF — and Georgia was selected for PCF
When PCF launched January 1, 2021, Georgia was a selected region. Many Georgia primary care practices that had observed CPC+ during 2017-2021 transitioned directly into PCF, applying CPC+ lessons to PCF participation. Atlanta-area integrated systems, Aledade Georgia, Privia Health Georgia, and independent Georgia primary care practices all leveraged CPC+ observations to inform PCF strategic decisions.
4. CPC+ shaped MCP — even though Georgia was not selected for MCP either
MCP design incorporated explicit CPC+ lessons (longer performance period, upfront infrastructure payment, deeper multi-payer alignment, mandatory Health Equity Plan). Georgia primary care leaders continue observing MCP as CPC+'s grand-successor.
5. CPC+ Functions framework persists
The five Comprehensive Primary Care Functions framework persists in primary care quality programs and PCMH recognition. Georgia primary care practices use the Functions framework even without CPC+ participation.
6. Multi-payer alignment lessons for Georgia Medicaid
Georgia Medicaid PCMH program (operating through Amerigroup, CareSource, Peach State Health Plan, etc.) drew design lessons from CPC+ multi-payer alignment. While Georgia Medicaid did not formally join CPC+, the multi-payer principle informed Georgia Medicaid value-based payment design.
Worked examples — six Georgia CPC+-era perspectives (historical, 2017-2021)
Example 1: Fulton 70 — Atlanta PCP non-CPC+ comparison (PY3 2019)
Maria, 70, was an Atlanta resident receiving primary care at a Piedmont Healthcare employed primary care practice in Fulton County during 2019. Maria was in Original Medicare. Her PCP was in MSSP through Piedmont's ACO.
Maria's PCP could not participate in CPC+ because Georgia was not selected. The practice operated under MSSP attribution: Maria's total cost of care was tracked across Piedmont's ACO. Maria's PCP did NOT receive CPC+'s Care Management Fee, Performance-Based Incentive Payment, or Comprehensive Primary Care Payment.
If Maria had lived in Knoxville, Tennessee — just 130 miles north — her PCP could have been in CPC+, receiving CMF, PBIP, and (in Track 2) CPCP plus Advanced APM status.
Example 2: DeKalb 75 — DeKalb FQHC tracking CPC+
James, 75, received primary care at a federally qualified health center serving low-income and dual-eligible patients in DeKalb County during 2018. The FQHC was not in CPC+ (Georgia not selected). FQHC leadership tracked Tennessee FQHC CPC+ participation, attending CPC+ multi-payer learning sessions and applying lessons to Georgia FQHC operations.
When PCF launched January 1, 2021 (Georgia selected), this FQHC's CPC+ observation directly informed its PCF participation decision.
Example 3: Cobb 68 — Cobb practice observing Tennessee CPC+
Linda, 68, received primary care at an independent practice in Cobb County during 2019. The practice was part of Aledade Georgia's MSSP ACO network. Aledade also operated in Tennessee (a CPC+ selected region), and Tennessee Aledade practices in CPC+ shared infrastructure and lessons with Georgia counterparts.
Aledade Georgia's value-based care infrastructure investments during 2017-2021 directly leveraged CPC+ operational lessons from Tennessee even without Georgia CPC+ participation.
Example 4: Worth County 72 — Albany rural primary care
Robert, 72, lived in rural Worth County during 2018 and received primary care at a small independent practice in Albany. The practice was not in any ACO or CMMI model. Standard FFS Medicare.
The practice could not have participated in CPC+ even if Georgia were selected — small rural primary care practices often lacked the value-based payment infrastructure prerequisites. But if Georgia had been selected, CPC+ Track 1 was specifically designed for practices like Robert's to begin building advanced primary care capabilities with CMF support.
Example 5: Bibb 80 — Macon practice comparison
Patricia, 80, received primary care at an Atrium Health Navicent affiliated primary care practice in Macon during 2020 (PY4, COVID-19 onset). Atrium Health Navicent's primary care arm was not in CPC+ (Georgia not selected). PY4 COVID-19 disruptions affected CPC+ practices nationally, with CMS adjustments to PBIP reconciliation and CMF payments.
Atrium Health Navicent leadership observed CPC+ COVID-era adjustments to inform GA practice operations during 2020.
Example 6: Hall 67 — Gainesville primary care lessons (PY5 2021)
Robert, 67, received primary care at a Northeast Georgia Physicians Group practice in Hall County (Gainesville, Atlanta MSA) during 2021. NGMC's primary care arm was not in CPC+ but was preparing for PCF (which launched January 1, 2021 with Georgia selected).
Hall County practices applying CPC+ observation lessons to PCF participation in 2021 represented the most direct CPC+-to-PCF knowledge transfer for Georgia.
14 best practices learned from CPC+ era for Georgia primary care
- Build the five Comprehensive Primary Care Functions even without CPC+ — they define advanced primary care
- Develop risk-stratified care management — staple of value-based primary care
- Integrate behavioral health into primary care — core CPC+ Function 3 lesson
- Operate 24/7 patient access infrastructure — Function 1 access requirement
- Use patient-reported outcomes — Function 4 engagement requirement
- Build population health analytics — Function 5 capability
- Engage state Medicaid for aligned PCMH — multi-payer principle
- Engage commercial payers for aligned primary care contracts — multi-payer extension
- Risk-stratify Medicare panel — CMF tiering principle applies even without CPC+
- Document care management workflow — quality measure submission requirement
- Build prospective payment readiness — CPCP-style partial prospective payment is the future
- Pursue NCQA PCMH recognition — durable infrastructure
- Plan for Advanced APM — Track 2 qualification informed later Advanced APM strategy
- Apply CPC+ lessons to PCF participation — direct knowledge transfer for Georgia practices
14 common issues (historical CPC+ era and lessons forward)
- CPC+ had no upfront infrastructure capital — fixed in MCP with one-time Upfront Infrastructure Payment
- Track 1 / Track 2 separation was rigid — MCP brought back glide path more flexibly
- PBIP was capped low — PCF and MCP increased risk corridors
- CPCP started low at 10% — PCF made primary care more prospective
- Multi-payer alignment was uneven across regions — MCP requires deeper state Medicaid commitment
- Quality measure burden was substantial — streamlined in PCF and MCP
- Behavioral health integration was hard — remains hard; MCP emphasizes
- Care management staffing was costly — CMF helped but practices subsidized
- EHR optimization was time-consuming — Functions required years to mature
- COVID-19 disrupted PY4-PY5 — required special CMS adjustments
- CPC+ savings not significant in net — drove PCF and MCP redesigns
- Health equity not explicitly required — MCP mandates Health Equity Plan
- Five-year performance period was short — MCP extended to 10.5 years
- Many CPC+ practices struggled to transition to PCF — operational learning applied
25 frequently asked questions
1. What was Comprehensive Primary Care Plus (CPC+)? The CMS Innovation Center's foundational voluntary multi-payer advanced primary care medical home model, predecessor to PCF and MCP. Ran January 1, 2017 – December 31, 2021.
2. Was CPC+ mandatory? No. Voluntary; approximately 3,000 practices applied and were selected across 18 Cohort 1 + 14 Cohort 2 regions.
3. When did CPC+ start and end? January 1, 2017 launch (Cohort 1); January 1, 2018 (Cohort 2 added); December 31, 2021 sunset.
4. How many practices participated? Approximately 3,000 primary care practices.
5. How many regions were selected? 18 in Cohort 1; 14 additional in Cohort 2 (some overlap in expansion regions).
6. Was Georgia a selected region? No. Georgia was NOT selected in either cohort. Tennessee was selected in Cohort 1, providing border observation.
7. What were the two CPC+ tracks? Track 1 (Foundational, NOT Advanced APM) and Track 2 (Comprehensive, Advanced APM eligible).
8. Was CPC+ Advanced APM? Track 2 qualified as Advanced APM under Section 1833(z) SSA. Track 1 did NOT.
9. What were the three payment components? Care Management Fee (CMF), Performance-Based Incentive Payment (PBIP), and Comprehensive Primary Care Payment (CPCP, Track 2 only).
10. What was the CMF? Per-beneficiary-per-month payment, risk-adjusted by complexity. Track 1: ~$15 PBPM base; Track 2: ~$28 PBPM base. Higher tiers for very complex patients.
11. What was the PBIP? Annual at-risk payment based on quality and utilization performance. Track 1 up to $2 PBPM; Track 2 up to $4 PBPM.
12. What was the CPCP? Comprehensive Primary Care Payment — Track 2 only. Partial prospective payment replacing portion of primary care E&M FFS. Started at 10% replacement, increased to up to 65% by PY5.
13. What were the five Comprehensive Primary Care Functions? (1) Access and Continuity, (2) Care Management, (3) Comprehensiveness and Coordination, (4) Patient and Caregiver Engagement, (5) Planned Care and Population Health.
14. How many multi-payer partners did CPC+ have? More than 70 commercial insurers and state Medicaid agencies across the 18 + 14 regions.
15. Did CPC+ save Medicare money? Mixed results; formal CMMI evaluation found no statistically significant net Medicare savings overall. Findings drove PCF and MCP redesigns.
16. What was CPC Classic? The predecessor model (October 1, 2012 – December 31, 2016), four-year-three-month voluntary multi-payer in 7 regions with ~500 practices.
17. What was the difference between CPC+ and PCF? PCF (2021-2026) made primary care more prospectively paid through Total Primary Care Payment, all participants Advanced APM, payment tiers based on complexity from day one (no Track 1/2), broader regional eligibility including Georgia.
18. What was the difference between CPC+ and MCP? MCP (2024-2034) is longer (10.5 years), has upfront infrastructure payment, three-track glide path, deeper multi-payer alignment, mandatory Health Equity Plan, ADI data.
19. Why was Georgia not selected for CPC+? CMS selected regions based on existing multi-payer infrastructure, state Medicaid commitment, commercial payer participation, and primary care transformation maturity. Georgia did not meet selection criteria for either cohort.
20. Could Georgia primary care practices learn CPC+ lessons? Yes. Georgia primary care leaders observed CPC+ closely, attended multi-payer learning sessions, and applied lessons to Georgia Medicaid PCMH, GA integrated system primary care strategy, and later PCF participation.
21. Did CPC+ lead to NCQA PCMH recognition? Many CPC+ practices already held NCQA PCMH recognition; the CPC+ Functions framework drew from NCQA PCMH standards. CPC+ participation often complemented PCMH recognition.
22. Did CPC+ change beneficiary cost-sharing? No. Beneficiary out-of-pocket followed standard Medicare rules.
23. How did COVID-19 affect CPC+? PY4 (2020) and PY5 (2021) included COVID-19 disruptions. CMS made adjustments to CMF payments, PBIP reconciliation, quality measurement, and other model elements.
24. Where can I learn more about CPC+? CMS Innovation Center CPC+ archive at innovation.cms.gov/innovation-models/comprehensive-primary-care-plus. QPP Service Center 1-866-288-8292.
25. What's the relationship between CPC+ and ACO REACH? CPC+ and ACO REACH operated separately. ACO REACH (and predecessor Direct Contracting) focuses on total cost of care for attributed beneficiaries. CPC+ focused on practice-level primary care transformation payment. Some practices participated in both.
Why CPC+ matters for Georgia primary care history
CPC+ is the foundation under everything modern Medicare primary care payment does. The 3,000-practice nationwide cohort that participated in CPC+ during 2017-2021 demonstrated at scale that multi-payer advanced primary care medical home transformation was operationally feasible, that care management infrastructure could be deployed broadly, that population health analytics could be integrated into primary care workflows, that behavioral health integration was achievable, and that quality measurement and patient-reported outcomes could be operationalized.
CPC+ also taught CMS what does not work: rigid track separation that limits flexibility, low at-risk payment that limits accountability, partial prospective payment that leaves too much fee-for-service economic dependency, no upfront infrastructure capital, no health equity requirement, and a five-year performance period too short for mature transformation. Every one of these lessons shaped PCF (2021-2026) and MCP (2024-2034).
For Georgia, CPC+ matters because the state's primary care leaders observed CPC+ during 2017-2021 from the sidelines, applied its lessons to Georgia Medicaid PCMH design and integrated system primary care strategy, and then directly leveraged CPC+ knowledge when PCF launched January 1, 2021 with Georgia as a selected region. Georgia primary care practices currently in PCF Cohort 2 (sunsetting June 30, 2026) trace their value-based payment infrastructure investments back through PCF participation to CPC+ observation.
For Georgia primary care practice leaders today, CPC+ matters because: (a) the five Comprehensive Primary Care Functions framework remains the durable definition of advanced primary care; (b) risk-stratified care management built into your practice came from CPC+ lessons; (c) population health analytics infrastructure built in your practice came from CPC+ infrastructure investment; (d) behavioral health integration in your practice came from CPC+ Function 3 work; (e) the next CMMI primary care model — likely launching in the early 2030s when MCP matures or sunsets — will draw further lessons from CPC+ → PCF → MCP evolution.
CPC+ is over. But its lessons live in PCF, in MCP, in Georgia Medicaid PCMH, in Georgia commercial primary care contracting, in every Georgia primary care practice that has built care management infrastructure during the past decade.
Contacts
- Medicare — 1-800-MEDICARE (1-800-633-4227), www.medicare.gov
- CMS Innovation Center (CPC+ archive) — innovation.cms.gov/innovation-models/comprehensive-primary-care-plus
- CMS Innovation Center (PCF successor) — innovation.cms.gov/innovation-models/primary-care-first
- CMS Innovation Center (MCP) — innovation.cms.gov/innovation-models/making-care-primary
- QPP Service Center — 1-866-288-8292 (qpp.cms.gov)
- Palmetto GBA (Jurisdiction J MAC) — 1-866-238-9650
- GeorgiaCares SHIP — 1-866-552-4464
- Medicare Rights Center — 1-800-333-4114
- Atlanta Legal Aid — 404-377-0701
- GA Legal Services — 1-800-498-9469
- 211 Georgia — dial 2-1-1
- Eldercare Locator — 1-800-677-1116
- Acentra Health QIO — 1-844-455-8708
- SSA — 1-800-772-1213
- Aledade — 301-565-3225 (aledade.com)
- Privia Health — 571-915-2080 (priviahealth.com)
- Georgia Primary Care Association — 770-455-0429 (gaprimarycare.org)
- NCQA — 202-955-3500 (ncqa.org)
Last verified: May 14, 2026 Status: In review Pillar: Medicaid / Medicare (Georgia) Voice: Policy translator