The Center for Medicare & Medicaid Innovation (CMMI) has unveiled a new strategy designed to foster equitable patient outcomes through “high-quality, affordable, person-centered care.” The approach is oriented around five key objectives that will guide its future payment models and priorities, including expansion of payment models designed to reduce health care costs and improve quality — the twin aims of value-based care initiatives.
“The health system must recognize and meet people’s medical needs by considering their preferences, values, and circumstances, should strive to keep people healthy and independent, and help providers coordinate care seamlessly and holistically across settings in a manner that puts people at the center of their own care,” CMMI said in a document outlining its new strategy.
The Affordable Care Act established CMMI to test innovative payment and service delivery models that have the potential to reduce federal expenditures, while maintaining or improving the quality of care for beneficiaries. These include programs such as Medicare Advantage, the Medicare Care Choices Model, Primary Care First and direct contracting. CMMI has tested more than 50 models since its inception. Only six of these have become permanent to date.
CMMI undertook an internal review of its first decade of work and consulted external researchers and experts as it developed its new approach.
First among the five objectives is to drive expansion of accountable care and increase the number of beneficiaries in relationships with such entities. These could include physician group practices, Medicare Advantage plans, accountable care organizations (ACO), or PACE programs, among many others. In 2020, 67% of Medicare beneficiaries enrolled in Part A and Part B were in MA plans or were attributed to an ACO, according to CMMI.
“Accountable care is to give all participating providers the incentives and tools to deliver high-quality, coordinated, team-based care that promotes health, thereby reducing fragmentation and costs for people and the health system,” CMMI indicated.
A second key goal is to advance health equity. CMMI announced that all new models will require providers to gather and report the demographic data of their beneficiaries and data on social needs and social determinants of health.
The agency also aims to develop systems to support integrated, person-centered care. These may include actionable, practice-specific data, technology, dissemination of best practices, peer-to-peer learning collaboratives, and payment flexibilities.
Enhancing affordability is a key goal. CMMI has pledged to pursue strategies to address health care prices, affordability, and reduce unnecessary or duplicative care.
“As cost pressures mount on individuals and families, CMS Innovation Center models will focus not only on reducing federal health expenditures, but also how they can help lower out-of-pocket costs for Medicare and Medicaid beneficiaries and maintain access to quality care,” the CMMI document stated.
The center’s fifth objective is to develop new partnerships to achieve these aims. CMMI will work to align policies across the components of the U.S. Centers for Medicare & Medicaid Services (CMS) and “aggressively” engage payers, purchasers, providers, states and beneficiaries to improve quality, to achieve equitable outcomes, and to reduce health care costs.
Informing these moves are lessons CMMI says were learned during its first decade of work. This includes identification of a need to streamline the model portfolio and reduce complexity, and the development of tools to assist providers as they assume more financial risk in emerging payment models.
“Broad transformation of health systems and markets should support the delivery of care that is consistent with people’s goals and values, is culturally and linguistically responsive, and focuses on what matters to them, such as their health outcomes and functional status,” according to CMMI.
