CMMI Director: Expect More Mandatory Value-Based Care Payment Models
By Robert King
Going forward, more payment models may be mandatory, according to Centers for Medicare and Medicaid Innovation (CMMI) head Liz Fowler. Speaking recently with Health Affairs Editor-in-Chief Alan Weil, Fowler noted there are significant disadvantages to voluntary models, ones that make it difficult to produce savings systemwide. "What we have learned from CMMI models over the past 10 years is that voluntary models [are] subject to risk selection, which has a negative impact on the ability to generate system-level savings," she said.
While providers who are doing well in a particular payment model tend to stay in the program and those who are not producing revenue tend to leave, the CMMI federal statute that measures the success of a model is based on whether it affects costs system-wide. CMMI is currently conducting a review of existing payment models and aims to make them more patient-centric. The goal, Fowler explained, is to guarantee that each Medicare and Medicaid beneficiary has a care relationship that "includes meaningful accountability for quality and total cost of care." Additionally, she would like to shift toward a "continuum of accountable care relationships" — ranging from a primary care practice to an accountable care organization or direct contracting entity, federal health center or a Medicare Advantage plan — that could lead to using more virtual care and telehealth to enhance the overall cost of care.
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