“In 2010, the Affordable Care Act (ACA) created the Center for Medicare and Medicaid Innovation (Innovation Center). The Innovation Center aims to create a more value-based system that reduces spending while preserving or enhancing quality of care. As staff who worked on drafting and implementing the ACA and on innovations at the state level, we knew that rising health care costs posed a threat to Medicare’s financial sustainability, state Medicaid budgets, and household spending, and we also knew that our fragmented and siloed health system was not delivering the best care for the money we were spending. We knew that we needed innovative solutions to bend the cost curve and ensure that every American had access to high-quality health care…”
“After launching more than 50 alternative payment models that reward health care providers for delivering high-quality and cost-efficient care, the Innovation Center has learned a great deal and is ready to build a stronger and more sustainable path forward. Beneficiaries, providers, and other stakeholders are encouraged by the work of existing models and are calling on the Innovation Center to leverage those lessons…”
“Reviewing this experience generates six key takeaways:
- The Innovation Center should make equity a centerpiece of every model. Models to date have been largely Medicare-oriented, and voluntary models have primarily drawn only those health care providers and organizations with resources and capital to apply and participate, resulting in limited attention to Medicaid and safety net providers…
- Offering too many models is overly complex, particularly when models overlap. The Innovation Center has launched over 50 models since its inception and is currently running 28 models concurrently. Testing too many models at once can create opposing, even conflicting incentives and burden model participants with figuring out the model hierarchies and interactions…
- The Innovation Center needs to re-evaluate how it designs financial incentives in its models to ensure meaningful provider participation. While voluntary models can demonstrate a proof of concept, they limit the potential savings and full ability to test an intervention, because participants opt in when they believe they will benefit financially, and opt out (or never join) when they believe they are at risk for losses.
- Providers find it challenging to accept downside risk if they do not have tools to enable and empower changes in care delivery. The Innovation Center should ensure providers have options for manageable levels of risk as well as what they need to take on more risk, such as waivers, support in transforming care (particularly for vulnerable populations), and data…
- Challenges in setting financial benchmarks have undermined our models’ effectiveness. To address these technical issues, the Innovation Center is evaluating options to ensure models are not resulting in overpayment and exploring opportunities to improve or replace the current risk adjustment methodology.
- Innovation Center models can define success as encouraging lasting transformation and a broader array of quality investments, rather than focusing solely on each individual model’s cost and quality improvements…” Read the full article here.
Source: Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years – By Chiquita Brooks-LaSure, Elizabeth Fowler, Meena Seshamani and Daniel Tsai, August 12, 2021. Health Affairs.
