Accountable Care for All: One Year Update on the CMS Innovation Center Strategy Refresh
Post Written by Kalin Scott, Senior Advisor
Innovation Center Strategy Refresh Update
In November 2022, the Centers for Medicare and Medicaid Services (CMS) Innovation Center released its one-year update on implementation and outcomes of its refreshed strategic vision and objects. The report takes the original strategy framework and provides greater detail and context on the tactical approaches CMS is leading to expand high-quality, person-centered care, advance health equity, increase access for Medicare and Medicaid members, and promote transparency. CMS also released a supplemental document focused on the technical details of each goal, metrics, and evaluation strategies.
While the Innovation Center strategy has many aims, the commitment to ensuring all Medicare members and nearly all Medicaid members are included in value-based payment arrangements by 2030 is most significant. Medicare and Medicaid cover nearly 1 out of every 3 Americans – CMS’s commitment to accountable care and value based models is poised to fundamentally transform how healthcare is paid for and delivered.
The CMS update reviews stakeholder engagement over the past year and plans to accelerate Medicare and Medicaid member engagement in the coming year.
New Focus: Specialty Care Integration
The accompanying blog, written by Innovation Center director Liz Fowler and other senior policy makers, summarizes the update, and also calls attention to the need to focus on ensuring access to specialty care to fully meet Medicare and Medicaid patient needs. Fowler and team reference the ‘ongoing trend of market consolidation’ and its influence on access to specialty care. “Market consolidation may dampen value-based incentives,” Fowler writes, “in part because hospital-employed physicians are often paid by volume of procedures, which reward referral volume.”
Expect to see more of a focus from CMS on value-based models targeted at specialty care – especially oncology and cardiology – and direction to providers to ensure access and integration with primary care. This focus from the Innovation Center will be outlined in more detail in 2023, alongside strategic objectives identified in the initial strategy refresh overview.
Additional Focuses in 2023
The update outlines CMS goals for the next year:
accelerated implementation of a ‘beneficiary engagement strategy’ across models, incorporating patient and caregiver perspectives through listening sessions,
development of a “Transformation Framework” to outline and measure metrics of CMS payment models that go beyond cost, quality and utilization, and
continued focus on multi-payer alignment in value-based payment (VBP) through models that engage more than one payer, align quality metrics, and support data exchange.
Stakeholders can expect to see more white papers, roadmaps and frameworks from the Innovation Center team in 2023 with details on these initiatives.
Recap: 2021 Innovation Center Strategy Refresh
CMS’s Innovation Center (also sometimes referred to as CMMI, or the Center for Medicare and Medicaid Innovation) plays a significant role in developing, testing and implementing new care and financial models for Medicare and Medicaid members and their providers. The Innovation Center was created as part of the Affordable Care Act and is the driving force behind CMS efforts to expand value-based models in Medicare and Medicaid.
In 2021, CMS published a series of Health Affairs articles and agency frameworks to outline the agency’s strategic vision for Medicare, Medicaid and the Innovation Center. The dominant themes included a to advance health equity and drive accountable, person-centered care. In Fall 2021, the Innovation Center published a white paper outlining a “strategy refresh” for the next ten years.
The 2021 Strategy Refresh and 2022 One-Year Update reinforce the Innovation Center’s focus on the development and expansion of VBP models focused on controlling costs while improving quality and outcomes for patients.
In the next decade, the Innovation Center will pursue a vision of “a health system that achieves equitable outcomes through high quality, affordable, person-centered care” through five distinct objectives:
Drive Accountable Care
Advance Health Equity
Support Innovation
Address Affordability
Partner to Achieve System Transformation
Significantly, CMS has committed to ensure nearly all Medicare and Medicaid members will be in VBP arrangements before the end of the decade. Specifically, CMS outlines that by 2030:
All Medicare beneficiaries will be in accountable care relationships
The vast majority of Medicaid beneficiaries will be in accountable care relationships
All Innovation Center models will include some form of multi-payer alignment
Accountable care relationships are defined as care relationships between a patient and a provider with accountability for quality and total cost of care. The white paper and one-year update also outline other commitments for the future of the Innovation Center:
Ensure health equity is embedded in every model
Reduce complexity of models and streamline the portfolio
Support providers in model participation and taking risk through the release of CMS tools and data
Ensure Medicare and Medicaid beneficiaries in underserved areas can access participating providers
Focus on sustainability of model efforts and lasting care delivery transformation
What Does This Mean for Providers?
This update and the initial strategy refresh clearly outline CMS’s policy priorities and commitment to value-based care. Medicare, Medicaid, and multi-payer value-based models will continue to be developed and implemented, and fee-for-service will continue to be phased out. Providers who have a strategy to participate and partner in these efforts will be well-positioned to make the most of these opportunities, improve outcomes for their patients, and build financially sustainable models.
In recent months, CMS has approved 1115 Medicaid waivers with investments that advance health equity, address health-related social needs, and hold providers, plans, and state Medicaid plans accountable for improving outcomes for Medicaid members. Recent discussions at CMS’s Health Care Payment Learning & Action Network (HCP-LAN) Summit reinforced the agency’s timeline and milestones for the adoption of VBP models across its programs. The Innovation Center’s strategy refresh update further underlines a multi-year commitment and approach to improved, accountable, comprehensive care for Medicare and Medicaid members.
If you’re a health or social care provider serving Medicare or Medicaid patients, you need to have a value-based care strategy. Reach out to us to learn more.
About the Author: Kalin Scott is a Senior Advisor at HSG.
