An industry group representing 42 different patient, payer, provider and purchaser organizations is calling on the Centers for Medicare & Medicaid Services (CMS) to maintain its momentum toward value-based payments—but keep what’s working in the current system along the way.
The Health Care Transformation Task Force (HCTTF) shared its thoughts in a Nov. 20 letter responding to a request for information about possible new directions for the Center for Medicare & Medicaid Innovation (CMMI), the government agency’s test lab for value-based payment models. Among the members of HCTTF are HealthSouth (NYSE: HLS), one of the largest post-acute provides in the U.S., and insurance giants like Aetna (NYSE:AET) and Anthem.
The letter comes as voluntary value-based care models are attracting participants across the health care continuum—even without CMS’ urging.
“We would like CMS to continue support for promising models while balancing the current portfolio with new, innovative payment models,” Clare Wrobel, director of payment reform models at HCTTF, told Home Health Care News. “[But] it would be a mistake to discard current models that providers have already invested in and are showing real promise.”
In its letter, the task force asked for more flexibilities and waivers afforded to in-home and post-acute care, which are already working. The HCTTF urged CMS to further streamline the waiver process by addressing issues such as inconsistent waiver availability and flexibility.
Private sector solutions
There are also some private sector models that warrant testing in Medicare and Medicaid, the group noted.
“In particular, we support more innovative payment and delivery models in Medicare Advantage, which has not been afforded as many opportunities to test out new models of care,” Wrobel said. “CMS should also support more alignment across payers to reduce provider burden when taking on new payment models.”
CMS should also take steps to incorporate feedback from model participants and consumers as part of the new agenda, the group said. Suggestions included establishing a technical expert panel to review new models and make recommendations to improve current models, or establishing an alternative payment model ombudsman that would work with the Medicare ombudsman.
Here are the key principles the HCTTF would like to see in the CMS design of any new models:
—Create a better business case for delivery system innovation.
—Expand flexibilities for providers to control cost and quality.
—Improve price, quality, and model transparency.
—Support private sector innovations.
—Define meaningful metrics for evaluating all models.
Additionally, CMS should support more alignment across payers to reduce provider burden when taking on new payment models. Some U.S. states are positioned to drive more alignment among public and private insurance plans, which is why CMS should commit to funding additional State Innovation Model awards, Wrobel said.
Keeping what works
The call for change doesn’t mean CMS should overhaul the entire system and discard promising models that providers have already invested in. The four Medicare Accountable Care Organization (ACO) programs reduced gross Medicare spending by $836 million in 2016, returning $70.6 million in net savings to the Medicare Trust Fund, according to CMS data the HCTTF touted.
Those models include the Medicare Shared Savings Program, Pioneer and Next Generation ACOs, and the Comprehensive ESRD Care Model.
“The recent evaluation of the Bundled Payment for Care Improvement shows that providers are referring to post-acute care in a more deliberate way,” Wrobel said. “And in Medicare Advantage, Humana recently reported that medical costs were 15% lower among physicians under a value-based payment arrangement when compared to providers under fee-for-service.”
The recent progress is why CMS shouldn’t eliminate existing models before providers have a chance to see what’s working and what isn’t.
“Transformation and evaluation takes time,” Wrobel said. “That’s why CMS shouldn’t eliminate existing models midway before providers have a chance to realize a return on their investments, and before we have a chance to see the data.”
Read the full letter here.
Written by Tim Regan