Payers, Orgs Provide Feedback on CMS Value-Based Care Reform
Healthcare payers and related organizations state that implementing CMS value-based care reform requires several market-focused investments.
Source: Thinkstock
By - CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management, and scaled technology investments.
CMS’s Innovation Center (CMMI) previously issued a Request for Information (RFI) from health plans, medical associations, and analysts to evaluate strategic improvements for lowering costs while improving outcomes in Medicare and Medicaid programs.
The agency found that organizations generally concurred that improving provider accountability, chronic disease care, patient healthcare choices, and value-based provider incentives are keys to the agency’s reform goals.
In addition, healthcare organizations suggested that utilizing innovative technologies may reduce associated burdens of integrating value-based payment models into healthcare systems.
“HHS has made shifting our healthcare system to one that pays for value one of our top four department priorities,” said HHS Secretary Alex Azar.
“Using bold, innovative models in Medicare and Medicaid is a key piece of this effort,” Azar continued. “We value stakeholder input on the new direction for the Innovation Center, and look forward to engaging on especially promising, groundbreaking ideas such as direct provider contracting.”
Healthcare payers, including Anthem and UnitedHealthcare, were among the organizations that submitted feedback to CMMI.
Anthem expressed an eagerness to support CMMI’s efforts to implement value-based reform but noted the potential for new value-based improvements.
“CMMI has taken a number of steps over the last seven years to facilitate the movement away from a fee-for-service (FFS) system that rewards volume and towards one that emphasizes value, quality, and innovation, but more can be done to truly transform healthcare payment and delivery,” Anthem stated.
The payer added that CMMI should test payment models to focus on patient-directed care where beneficiaries are equipped with transparency and tools to make informed healthcare decisions.
Anthem emphasized a need to enhance and reform EHR interoperability to support data-sharing that adequately informs patient-centered care.
“Despite recognition of the importance of interoperability, it has been widely documented that that EHR systems and fractured and siloed, and that more work is also needed to create adequate exchange of health information,” Anthem said.
“While CMS has made great strides in promoting access to and utilization of EHR, continued investments in its infrastructure are needed to secure the success of future CMMI tests.”
UnitedHealthcare shared experiences about its Health Home program to support CMMI’s objective.
Specifically, UnitedHealthcare’s Health Home program utilizes a healthcare model that focuses on patient-administered preventive care, chronic disease screenings, and physical and behavioral healthcare coordination to improve outcomes.
UnitedHealthcare clarified to CMMI that Medicaid beneficiaries are likely to experience improved health conditions at lower costs by streamlining clinical, preventive, and mental healthcare services.
“In our experience, the Health Home program supports some of the most vulnerable individuals within the Washington Medicaid population and functions as a bridge for integrated care within existing care systems,” UnitedHealthcare said.
CMS Administrator Seema Verma stressed that input from payers and other experts is critical in creating comprehensive healthcare reforms that improve healthcare quality through efficient reimbursement agreements.
“We recognize that the best ideas don’t come from Washington, so it’s important that we hear from the front lines of our healthcare system about how we can improve care” Verma said.
“The responses from this RFI will help inform and drive our initiatives to transform the health care delivery system with the goal of improving quality of care while reducing unnecessary cost.”
CMMI issued another RFI related to the development of a direct provider contracting model for use in Medicare FFS programs. Healthcare payers, providers, and other interested parties can submit comments here.
