CMS focuses on health equity, accountable care in its new strategic plan

For its second decade in operation, Centers for Medicare and Medicaid Services Innovation Center is implementing strategies to drive healthcare transformation, using demographic data, industry feedback and more accessible payment models.

In a Wednesday webinar, CMS leaders outlined the agency’s five new objectives and how they will advance health equity, expand coverage and improve health outcomes going forward.

Driving accountable care: The first goal guiding the agency’s work is to increase the number of people in relationships with providers that are accountable for patients’ costs and improving their care history, said Dr. Liz Fowler, CMS Innovation Center director, during the virtual conference.

This objective will require CMS to increase beneficiary access to advanced primary care and healthcare organizations to deliver value-based care at scale.

CMS envisions a future where every Medicare beneficiary and most Medicaid beneficiaries are in an accountable care relationship by 2030, said Purva Rawal, CMS Innovation Center chief strategy officer during the webinar.

Advancing health equity: CMS plans to collect data on race, geography, disability, sexual orientation, gender identity and other patient demographics while also engaging a broader range of provider types, including federally qualified health centers, rural health clinics, and other safety net providers, said Chiquita Brooks-LaSure, CMS administrator.

“As the first African American woman to lead CMS, I want to make sure that our programs are operating to reduce the health disparities that underlie our healthcare system,” she said during the webinar.

In thinking about policy and design changes to ensure disadvantaged communities have access to value based care arrangements, CMS should look beyond the triangle of food, housing and transportation toward other social drivers of health, said Hoangmai Pham, president and CEO of Institute for Exceptional Care.

While this explicit focus on equity is a point of interest, Pham said the “proof will be in the execution.”

Supporting innovation: To support model participants looking for ways to innovate care delivery approaches, the Innovation Center will offer actionable and practice-specific data technology, best practices, peer-to-peer learning collaboratives and payment flexibilities to address affordability.

A streamlined model portfolio with simplified parameters and less administrative burden will make it easier for providers to engage with the models, Fowler said. Patient-reported outcomes will be included as part of models’ performance measurements.

Pham said she prefers CMS’ new focus on outcomes that matter and promoting value based, person-centered care, instead of traditional, clinical guideline-driven metrics that are scientifically appealing to providers.

Addressing affordability: Acting as a responsible steward of public funds, CMS will continue to work on ways of identifying financial waste and fraud, preventing surprise bills and improper payments, Brooks-LaSure said.

In addition to reducing Medicare and Medicaid costs, CMS models will also try to lower patients’ out of pocket costs.

Both CMS and the federal government need to consider making the current volume-based model of fee-for-service less attractive in order to offer providers a better path and value based payments without costing Medicare or Medicaid dollars, Pham said.

Partnering to achieve system transformation: “CMS Innovation Center’s vision for broad health system transformation is ambitious, and requires collaboration,” Rawal said. “We need to align our priorities and policies across CMS and work in tandem with commercial payers, purchasers, states and beneficiaries to achieve our vision by 2030.”

The agency plans to engage communities in the policymaking and implementation process, use consistent mechanisms for gathering outside input, share more data with researchers and ask federal partners for their insight and support in testing new approaches to payment and care delivery.

In the coming months, CMS will conduct listening sessions and continue to publicly share its refresh strategy.

Industry stakeholders responded positively to the suggestions.

“We urge CMS to increase regulatory flexibility so providers can better innovate care and design new payment arrangements as well as to incent private payers to rapidly adopt alternative payment arrangements,” said Blair Childs, senior vice president, public affairs for group purchasing organization Premier. “As a first step to implementing this vision, we encourage CMMI to test innovations within the Medicare Shared Savings Program and make changes to Direct Contracting that would encourage more provider participation.”

In order to expand accountable care, CMS and the Innovation Center must work to grow MSSP, its permanent accountable care organization, said Clif Gaus, president and CEO of the National Association of ACOs, in a statement.

Previously, Premier has asked CMS to give ACOs more time to prep for MSSP reporting requirements, shift to value-based compensation and quality and performance-based metrics and extend telehealth waivers.