During the Value-Based Payment Summit, Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler, Ph.D., outlined the center’s plan for 2023. Dr. Fowler noted that the Biden Administration is planning to release three or four new payment models on advance primary care as well as a new model that would allow states to manage the total cost of care.
New Models
The models on advance primary care are part of a larger effort to increase the ranks of specialists in value-based care. Fowler noted that there will “be a focus on financial calculations and make it possible for more safety-net providers to participate,” with a continued focus on “addressing health equity.”
With respect to the model that would allow states the ability to manage the total cost of care, the model is expected to be similar to the partnership between the Centers for Medicare and Medicaid Services (CMS) and the state of Maryland. In that partnership, a budget was established for certain state hospitals, incentivizing them to eliminate unnecessary hospitalizations, thereby reducing Medicare spending and improving quality.
In 2020, the Maryland-CMS partnership was lauded as an example of a successful value-based care payment model as it was found to generate savings, meet quality metrics, and decrease hospitalizations.
Fowler has not yet specified how many states – or which states – would be impacted by the new cost-of-care model, but did note that input from “states and constituencies at the state level will be critical.”
Other Changes
Not only are the new payment models expected this year, but also the way in which model results are evaluated is likely to change this year. Fowler noted that a payment model must be certified to be expanded and certification can be a “narrow definition of success.” She also mentioned that CMMI is working on “a framework for judging impact based on the notion of health system transformation.”
CMMI hopes to not only understand whether individual models are meeting spending and quality criteria, but also if it is having a positive impact on the health system. Fowler is also looking for outcomes that may “be a recommendation for Congress for consideration in future legislation or incorporation of key elements into aspects of Medicare or Medicaid.”
Fowler also touched upon the start of the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) payment model, that offers full and partially capitated payments to physicians who meet certain benchmarks. The ACO REACH model is the first model that includes an adjustment to benchmarks depending on how well the provider is addressing health equity, and CMMI is “paying close attention to the equity design elements with the intention of scaling features that work and learning from challenges.”