New CMS Roadmap Puts the Spotlight on VBP
Written by Kalin Scott
Earlier this week, the Centers for Medicare and Medicaid Services issued a new roadmap for state Medicaid programs to ‘accelerate’ the adoption of value-based payment (VBP) strategies for their Medicaid populations. This is great news for providers, patients, stakeholders, and taxpayers: as the nation’s largest health insurance program, Medicaid provides the opportunity to transform our health care delivery system by aligning payment with value.
What does this mean for providers?
If you don’t have a VBP strategy, you need to create one now. The lack of a strategy means you’ll be left behind. The move to value is non-negotiable: Medicare, Medicaid, and commercial payers are moving away from the antiquated fee-for-service model and requiring providers and their partners to control costs, deliver better outcomes, and put the patient at the center of their care model. The benefit to providers? Stable revenue, the opportunity to take on risk, and share savings when better outcomes for patients are realized.
Background on Roadmap and CMS VBP Efforts
The CMS roadmap includes highlights of state and federal VBP approaches currently underway, along with a framework of the federal authorities (such as waivers and state plan amendments) that state Medicaid programs can use to advance VBP.
In its release, CMS highlighted goals of aligning value-based efforts for providers across payers, improving the quality of care, addressing the social determinants of health, and providing stability for providers during unexpected challenges such as the COVID-19 pandemic.
The release of the roadmap further underscores the need for providers and organizations in health and social care organizations to identify their VBP strategy.
CMS has a history of supporting and advancing VBP models, The Center for Medicare and Medicaid Innovation, within CMS, has released more than 40 new payment models since 2010. Most of these models have been focused on the Medicare population. CMS has also approved individual state-specific strategies for VBP, such as those in Tennessee, Massachusetts, Maryland, and Vermont, through various federal authorities. CMS approved New York Medicaid’s move to VBP — which began in 2015 — as part of the state’s Delivery System Reform Incentive Payment (DSRIP) waiver. The guidance released this week signals even stronger commitment by CMS to advance VBP across populations.
New York’s Move to VBP
VBP is the key to the future of health care — I’ve been up close to this effort in one state Medicaid program and have seen similar efforts spread across the country. Several years ago, I worked with New York Medicaid Director Jason Helgerson on building the state’s VBP strategy. We engaged more than 400 stakeholders in building out the model: technical and clinical experts, providers, consumer advocates, managed care organizations, social care providers, community-based organizations, and state agencies all had a role in the process. The first Value-Based Payment Roadmap was released in 2015 and pledged to transform the state’s health care delivery system and sustain the efforts built through the DSRIP program. New York was the first state to require advanced VBP contracts to incorporate community-based organizations and address the social determinants of health. The state committed to its efforts through thorough engagement and education of stakeholders in the health care system and continues to share valuable resources through today in its VBP Resource Library.
Since 2015, New York’s approach to VBP has been very successful — to date, more than 70% of all Medicaid managed care payments are value-based, with more than 40% in advanced value-based arrangements that share risk. The state’s VBP roadmap is updated annually with provider, stakeholder, and CMS feedback.
How can you get started on your VBP strategy?
If you don’t have a VBP strategy, creating one may feel overwhelming. There are many great resources available to support your efforts — I’ve linked a few state and federal resources, along with insights for providers by my colleagues below. And at HSG, working with health and social care providers on the move to value is a major focus of our work. We are well-versed on the ins and outs of value-based arrangements in multiple markets and have also released two playbooks focused on the fundamentals social care providers can focus on in their VBP strategies.
If you’d like to talk more about what this announcement means, share your reactions on my thoughts above or learn more about how we can help, get in touch. You can find me on Twitter @kalinscot or by email at kalin@helgersonsolutions.com — I’d love to hear what you think.
Press Release: CMS Issues New Roadmap for States on Value-Based Payment
State Medicaid Director Letter: Value-Based Care Opportunities in Medicaid
Jason Helgerson: Pandemic Lays Bare the Broken Health System, but There is Hope in the Rebuild
Juliette Price: New VBP Roadmap Change Expands Size of Pie for SDOH Investments
Addressing SDOH in a VBP World: A Playbook for Social Care Providers: Volume 1
Addressing SDOH in a VBP World: A Playbook for Social Care Providers: Volume 2
