Center for Medicare & Medicaid Innovation Seeks to Assess and Improve Program Trajectory
The Center for Medicare & Medicaid Innovation (CMMI), or the CMS Innovation Center, was created under the Affordable Care Act. CMMI seeks to study, conceptualize, and implement pioneering health care payment models. Since its inception, CMMI has created over fifty-four (54) payment models, but it does have the word “Innovation” in its name for a reason; of those 54 new payment models, only 5 have resulted in statistically significant savings.
In a virtual event by CMS’s Health Care Payment Learning & Action Network (LAN), Seema Verma, the Centers for Medicare & Medicaid Services (CMS) Administrator, addressed lackluster 2019 outcomes and highlighted key areas for improvement. “The Center stands in need of a course correction in model design and portfolio selection, if value-based care is to advance,” Verma said.
- The success of value-based care is dependent on the adoption of models with downside risk and the creation of meaningful benchmarks to measure success.
The drive to move the US healthcare system into value-based care models is a key priority for CMS. Value-based care comes with far more benefits than just cost savings. “In addition to payment, value-based care also means providing pricing transparency, strengthening interoperability and minimizing paperwork burden for providers” (homehealthcarenews.com, ¶9). With these benefits in mind, it is paramount that providers begin to adopt some element of downside risk. While it may seem counter-intuitive, CMS has found that “models where providers have downside risks have actually performed better” (homehealthcarenews.com, ¶13). Change is reliant on both sides though, and in addition to providers taking on more risk, CMS needs to establish clear benchmarks for what defines “success“ in a value-based payment model. While the actual changes are forthcoming, CMMI Director Brad Smith, acknowledged that “CMS and CMMI have been too generous or lenient in judging how new payment mechanisms are performing” (homehealthcarenews.com, ¶15).
- It’s not all bad news – some models are thriving and primed for expansion.
While both Seema Verma, CMS Administrator, and Brad Smith, CMMI Director, were largely critical of the impact of CMMI thus far, there were a few high points. The Home Health Value-Based Purchasing Model has been identified as one of CMMI’s most successful models, so much so that CMMI Director Smith referenced plans to expand the program nationally. And in addition to the Value-Based Purchasing Model, “Verma and Smith likewise pointed to the relatively new Primary Cares Initiative and the related Direct-Contracting model as impactful value-based care efforts” (homehealthcarenews.com, ¶23).
CMS and CMMI have thrown their support behind value-based care and the associated payment models. Collaboration between these entities, payers, providers, and every player in between is critical in taking this next step forward to advance value-based care.
Innovista Health Solutions is a population health management company that offers management and support services to guide independent physician networks, medical groups, and health systems through the ever-changing landscape of value-based care. With services and toolsets including network development, population health management, delegated services, data reporting, and strategic capital investments, Innovista is structured to help its clients succeed in their Commercial, Medicare, and Medicaid value programs. Innovista is a single resource for physician integrated models to gain access to innovative technology, expert programs, actionable data insights, financial resources, and growth opportunities, to navigate and succeed in value-based and/or risk-based contracts.
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