CMS Lays Out New Strategy for Advancing Value-Based Care, APMs

Health equity at the center of CMMI strategy refresh

While advancing health equity is one pillar of CMMI’s newest strategy, CMS leaders emphasized the role that particular pillar will play over the next couple of years.

“As the first African American woman to lead CMS, I wanted to make sure that our programs are operating through these health disparities that underlie our healthcare system, which were especially illuminated by the COVID-19 pandemic,” CMS Administrator Chiquita Brooks-LaSure said in a listening session yesterday.

“President Biden has made it clear that we’re going to address racial equity using a whole-of-government approach,” Brooks-LaSure continued. “As CMS, how are we promoting health equity will always be the first question we ask. Nevertheless, we are doing everything we can to break down barriers to care and lift up underserved communities.”

Unfortunately, lessons learned from the past ten years of CMMI’s existence show that full diversity in Medicare and Medicaid is not reflected in many alternative payment and care delivery models to date, the white paper states. Recent evaluations of the Next Generation ACO Model, for example, have shown that attributed Medicare beneficiaries were more likely to be white and less likely to be either dually eligible or live in rural areas compared to fee-for-service beneficiaries in the same areas.

CMMI plans to advance health equity through its models by requiring participants to collect and report demographic data and data on social needs and social determinants of health, as appropriate. New models will also include patients from historically underserved populations and safety-net providers, such as community health centers and disproportionate share hospitals, according to the white paper.

The latter issue being another main focus for CMMI as it homes in on health equity.

“The Innovation Center can do more to support model participants looking for ways to innovate care delivery approaches,” Liz Fowler, PhD, JD, Deputy Administrator and Director of CMMI, said during the listening session. “These supports include actionable and practice-specific data, technology, dissemination of best practices, peer-to-peer learning collaboratives, and payment flexibilities.”

To encourage greater value-based care adoption among safety-net providers, CMMI also said it plans to leverage upfront payments, social risk adjustment, new benchmark methodologies, and payment incentives to reduce disparities or screen for social determinants of health and coordinate care with community-based organizations. It will also offer more technical assistance, such as screening tools and data collection workflows.

Multi-payer engagement key to value-based care advancement

Another major theme coming from CMS officials is that CMMI cannot go at value-based care alone if they want greater value-based care adoption and sustainability.

“We need to align our priorities and policies across CMS and work in tandem with commercial payers, purchasers, and beneficiaries to achieve our vision by 2030,” Fowler explained. “We’d like all of our new models to incorporate multi-payer alignment, however possible.”

CMMI has learned that designs of models have not consistently ensured broad provider participation. One of the issues is that multi-payer models designed for Medicare providers have not resulted in high levels of participation from Medicaid and commercial payers, the white paper stated.

But CMMI is aware that “payers are in different stages of the value-based care journey with their own operational considerations.” It plans to build on lessons learned to “drive alignment on critical payment and operational design components such as clinical tools, outcome measures, and payment.”

CMMI also committed to partnering with community-based organizations to advance health equity, state and Medicaid partners, and beneficiaries to ensure person-centered models that align with their needs.

The future of value-based care

Advancing health equity and partnering for healthcare system transformation are just two objectives CMS and CMMI outlined in their new strategy. The agency also aims to reduce the percentage of beneficiaries that forgo care due to healthcare costs by 2030 by developing models that decrease duplicative or wasteful care and drive site of care differences.

Financial risk is also part of value-based care’s future under CMMI’s new strategy. Providers need tools to support the adoption of downside risk, CMMI has learned. In addition to the supports Fowler identified, CMMI also plans to improve sharing of more timely and actionable data to support provider decision-making and increase interoperability. Armed with data and additional support, CMMI aims to help primary care practices make the transition to more population-based payments.

Additionally, CMMI will test more population-based and advance payments, as well as per beneficiary per month payments, to increase participation in value-based care models.

More providers may also be required to participate in CMMI models, as voluntary models have led to risk selection and targeted provider participation.

“To avoid risk selection associated with voluntary models, examine whether mandatory models can increase quality and access for beneficiaries, as well as increase provider participation, without negatively impacting those who care for underserved populations,” the white paper said.

But rest assured, CMMI does not have plans to end existing models early as a result of the strategy refresh. However, the strategy may prompt changes to existing models, Fowler stated.