CMS lays out the future of value-based care

The Biden administration’s vision for the future of value-based care rests on curbing the number of CMS payment experiments and a greater focus on health equity.

CMS hopes to remake the U.S. healthcare system over the next decade by prioritizing coordinated, team-based care, measuring outcomes that matter to patients, and holding providers more accountable, top officials wrote in a Health Affairs blog on Thursday. The agency thinks simplifying its approach by cutting back the number of models would make participation easier for providers.

“Moving forward, the Innovation Center intends to focus on launching fewer models and scaling what works to become a part of the core Medicare and Medicaid programs,” the blog said.

The aim is to build a health system that eliminates disparities through high-quality, affordable and person-centered care.

“Achieving this goal requires centering equity in all stages of model design, operation, and evaluation, and aligning these concepts with other CMS programs,” the blog said.

That likely means a greater focus on getting Medicaid and safety-net providers involved in CMS’ Center for Medicare and Medicaid Innovation experiments.

“Models to date have been largely Medicare-oriented, and voluntary models have primarily drawn only those health care providers and organizations with resources and capital to apply and participate, resulting in limited attention to Medicaid and safety net providers,” the blog said.

The Medicare Payment Advisory Commission and other experts have recommended a similar approach to value-based payment to ensure widespread practice transformation and rein in Medicare spending. Experts say CMS needs a new strategy because providers and payers have been too slow to adopt value-based payment, especially arrangements that require providers to take on significant financial risk. In addition, most CMMI initiatives don’t systematically lower healthcare spending or improve quality, adding needless complexity.

Still, most experts agree that the continued viability of fee-for-service reimbursement is holding value-based care back more than anything else.

CMS officials plan to make more of the agency’s experiments mandatory while making it easier for providers to manage financial risk. The agency also wants to overhaul its spending and quality targets for providers to make its experiments more impactful.

“While voluntary models can demonstrate a proof of concept, they limit the potential savings and full ability to test an intervention because participants opt-in when they believe they will benefit financially and opt-out (or never join) when they believe they are at risk for losses,” the blog said.

The agency will also change how it evaluates its experiments. Historically, CMMI has judged its models based on whether they saved money or improved quality. But critics say that approach is too narrow and limits the agency’s ability to transform the healthcare delivery system. CMS officials favor a broader definition of success. Only six models have saved the federal government a significant amount of money, and just four expanded.

“As the Innovation Center identifies practices that work in models, there is commitment to scaling them, whether through certification and expansion or by incorporating what works into other Innovation Center models, Medicare, and Medicaid,” the blog said.

CMMI also plans to align its payment experiments with other CMS programs and commercial payers, making it easier for providers to participate in value-based payment across payers. That could encourage greater uptake.

“Successful implementation of our vision hinges on commitments that extend far beyond CMS programs, with change occurring at the level of patients and their care teams and through additional relationships with payers, purchasers, providers, patient advocates, as well as community-based organizations,” the blog said.

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Marie Maynes
Marie Maynes is a Sports enthusiast and writes for the Sports section of ANH.