In late 2021, the Center for Medicare and Medicaid Innovation (CMMI) introduced a strategic refresh, aiming to make value-based care payment models more equitable and meaningful to allow for greater participation from providers and patients in the years to come. In the strategy refresh, CMMI plans to focus on equity, paying for health care based on value to the patient instead of the volume of services provided, and delivering person-centered care that meets people where they are.
Advancing health equity was one of five strategic objectives/main pillars of the strategic refresh. It is likely that this year, providers will start to see some of the first signs as to how the vision will ultimately be implemented. While it’s likely that first signs will begin to emerge this year, providers will likely not see many new models launched this year. CMMI and CMS need time to go through the rulemaking and comment periods before any new model can be launched and put into practice.
At the time of the strategy refresh, CMMI officials said to expect fewer models in the near future, as too much overlap between models had caused confusion among providers.
CMMI added an ambitious goal, that by 2030, all models would have multipayer alignment and all Medicare beneficiaries (and most Medicaid beneficiaries) would be an accountable care relationship of some sort.
Advancing Health Equity
According to CMMI, “equity must be considered in all stages of model design, operation, and evaluation, and aligned with other CMS programs and initiatives.” CMMI expects that all new models will require participants collect and report demographic data of their beneficiaries and data on social needs and social determinants of health (in compliance with HIPAA and other applicable laws).
All new models will also include patients from historically underserved populations and safety net providers, such as community health centers and disproportionate share hospitals. CMMI would also work to identify areas for reducing inequities at the population level and then set targets for reducing those identified inequities.
Addressing Affordability
CMMI also announced plans to address health care prices, affordability, and reducing waste. As far as affordability, CMMI would consider addressing it through models that waive cost-sharing for high-value services, moderating drug prices, using models that target low-value care and sources of waste that drive up patient costs.
CMMI hopes to reduce the percentage of beneficiaries that forego care because of cost by 2030.
Direct Contracting
In addition to health equity, CMMI is starting to work towards implementation of the Direct Contracting model that allows providers to take on partially or fully capitated risk payments. While the first performance year for Direct Contracting started in April, CMMI did not take new applications for the start of the January 1, 2022, period. Organizations that applied in the previous application cycles—either for the Implementation Period or PY2021—and deferred their start date to January 1, 2022 will be permitted to start participating in the model as planned on January 1, 2022, as long as they continue to meet model requirements.