The Center for Medicare & Medicaid Innovation (CMMI) is in need of a “course correction,” top U.S. health care officials believe.
And part of that may include a national expansion of the Home Health Value-Based Purchasing Model.
Created under the Affordable Care Act, CMMI — also known as the CMS Innovation Center — supports the development and testing of innovative health care payment models. Since its formation, CMMI has developed at least 54 payment models, including the Home Health Value-Based Purchasing Model.
As U.S. health care costs continue to rise, CMMI’s work has grown increasingly important, especially around value-based care, according to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. National health care spending is expected to grow at an average annual rate of 5.4% from 2019 to 2028, outpacing the gross domestic product’s average annual growth rate of 4.3%.
But of those 54 payment models, only a handful appear to be working.
In fact, just five have shown statistically significant savings.
“In 2019 alone, over 450,000 providers participated [in those models], serving over 26 million patients,” Verma noted. “But more recently, the evaluation data for the early models have been completed. And unfortunately, the results are deeply concerning.”
Verma addressed CMMI’s progress and the future of value-based care on Tuesday during a virtual event hosted by CMS’s Health Care Payment Learning & Action Network (LAN). Verma was joined by Brad Smith, who co-founded and served as CEO of home-based palliative care provider Aspire Health before being named CMMI’s director in January.
“The Center stands in need of a course correction in model design and portfolio selection, if value-based care is to advance,” Verma said.
Providers ‘must have skin in the game’
Shifting the U.S. health care system toward value-based care is one of CMS’s many priorities, Verma remarked during the virtual event. In addition to payment, value-based care also means providing pricing transparency, strengthening interoperability and minimizing paperwork burden for providers.
When it comes to establishing more successful value-based payment models, CMMI needs to prioritize two pillars, Verma said.
First, it must step back from voluntary models “designed with an abundance of financial carrots to attract participation.”
“Models must incorporate design elements that require participants to have skin in the game,” Verma said. “Models where providers have downside risks have actually performed better.”
Secondly, CMMI needs to do a better job of developing effective, meaningful benchmarks to measure the success of value-based payment models.
Smith echoed that idea, pointing out that CMS and CMMI have been too generous or lenient in judging how new payment mechanisms are performing.
“CMMI has learned a tremendous amount over the past 10 years about value-based care arrangements, and we are grateful for the tremendous participation we have had to date in our models,” Smith said at the LAN event. “As we move into the next phase of the Innovation Center, we believe we must push even harder to move more providers into value-based care payment arrangements.”
Expanding the Value-Based Purchasing Model
While most of Tuesday’s remarks took a hard look at what CMMI has accomplished thus far, both Verma and Smith did point out several positives.
Smith, for instance, called out the Home Health Value-Based Purchasing Model as one of the Innovation Center’s most successful efforts.
Implemented in 2016, the Value-Based Purchasing Model was designed to pay home health providers in nine states based on outcomes and the value of services delivered. This year was the sixth year of CMMI testing out the model, exposing home health providers to 6% upside or downside risk based on their performance.
Home health providers in participating states have mostly supported the value-base model, with many calling for a national expansion beyond the current states of Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington.
CMMI hasn’t hinted it has any plans to do so — until now.
“As we look at our portfolio, we have other models that we believe may be able to expand in the coming years,” Smith said. “For example, our Home Health Value-Based Purchasing Model has shown significant cost savings and improvement on key quality metrics. It’s one of the examples of the models that we’re looking at to think about if we could expand it nationally in the next year or so.”
Besides the Value-Based Purchasing Model, Verma and Smith likewise pointed to the relatively new Primary Cares Initiative and the related direct-contracting model as impactful value-based care efforts.
“Last year, we announced the CMS Primary Cares Initiative, featuring the direct contracting model, which has the potential to drive quality and value across the entire system in a way that we’ve never seen before,” Verma said. “Going forward, we believe direct contracting can take an exciting new step with a geographic option, in which a set of entities would take on full risk for all eligible Medicare beneficiaries in a certain region.”
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