The Center for Medicare and Medicaid Innovation (CMMI) announced its approach to President Donald Trump and Secretary Robert F. Kennedy’s call to “Make America Healthy Again” – and it promises to, among other aims, increase patients’ ability to receive care in the setting of their choice, including the home. 

The new strategy, announced Tuesday, also includes a plan that could scale back centralized rate-setting and require providers to take on downside risk for all alternative payment models.

“Aligning to our statutory mandate, [we will] work to ensure that our model tests reduce costs and have a pathway to scale into permanent Medicare, Medicaid and CHIP programs,” CMMI’s director, Abe Sutton, said on a Tuesday webinar. “We will accomplish this, for instance, by strengthening model design, requiring downside risk, prioritizing high value care services and reducing low value care. We will work to reduce the role of rate setting in our program. It is through this lens that we will assess new and existing models with the intention of curbing Medicare and Medicaid spending, protecting our federal programs and right-sizing the focus of our health care system on our patients.”

CMMI’s overall approach includes three pillars: promoting evidence-based prevention of chronic illnesses and decline of function and cognition in older adults, empowering patient choice and driving competition in health care markets.

The Innovation Center aims to promote patient choice in coverage, sites of care and care providers. Its models can require site-neutral payments across settings through changes to certificate of need requirements, according to a CMMI release, and therefore support expanded scopes of practice, virtual care and at-home care.

“[Giving patients more options for care] involves engaging new provider types that have not traditionally stepped forward to participate in our models, such as independent and rural practices, to participate in innovation center models and enable home-based care,” Sutton said. “Choice means that patients will be better able to find providers in their communities who best meet their unique needs, and then the setting that works best for them all, while driving down costs to make care more affordable.”

The center also announced that models could create waivers that would allow and incentivize providers to deliver preventative care, including caregiving.

CMMI gave two examples of potential waivers. One would allow accountable care entities that assume global risk to provide durable medical equipment (DME) that could bypass National Coverage Determinations if they support patients transitioning to or staying in their homes. Another example is reduced cost-sharing for high-value or preventive services to caregivers serving those who experience cognitive or functional decline.

Sutton did not provide an exact date on when providers could expect to hear specifics about modifications to existing models or the creation of new models.

“I’m going to have to ask you to stay tuned on that one,” Sutton said on a webinar. “I look forward to sharing more information about the modifications we are making to existing models to align them to our strategy and to our statutory mandate. We are going to make several announcements over the coming months around new model concepts and the updates to existing models.”

Since its launch in 2010 under the Affordable Care Act (ACA), CMMI has launched over 50 models. One model crucial to at-home care providers, the Home Health Value-Based Purchasing (HHVBP) Model, is among only six models that CMMI said have accomplished its overall mission.

The HHVBP model is unlikely to undergo any major changes under CMMI’s Make America Healthy Again strategy, according to Fred Bentley, managing director in ATI Advisory’s care continuum strategy and solutions practice. However, CMMI’s statements regarding site neutrality and care setting flexibility raise other questions, he said.

“Will they make the hospital-at-home demonstration program permanent?” Bentley said to Home Health Care News’ sister publication, Skilled Nursing News. “That’s still up in the air. That also requires legislation, but CMMI can still push on hospital-at-home. There has been interest in creating a [skilled nursing facility] (SNF) at home model. I don’t want to overstate that, all of a sudden, that of SNF business is going to leave the skilled nursing facility and go to … home-based care settings. But, there could be an experiment there and a push on that.”