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The Center for Medicare & Medicaid Innovation (“CMMI”) has announced a new strategy for establishing payment systems that incentivize healthier lives through a focus on three key pillars: (1) promoting evidence-based prevention; (2) empowering patients to achieve their health goals; and (3) driving choice and competition. This strategy includes several positives for providers participating (or considering participation) in CMMI’s alternative payment models, including efforts to reduce administrative burden for participants, increase predictability through reducing significant mid-model changes and increased access to prospective payments and advanced shared savings. However, CMMI has also signaled an intent to prioritize models that include downside risk, with a likely requirement that at least some of that risk is borne by providers.
Separately, CMMI Director Abe Sutton recently indicated that CMS is abandoning its previously stated goal to have all fee-for-service Medicare beneficiaries under accountable care arrangements by 2030. Together, these changes signal a new direction for Medicare’s value-based alternative payment models, one which health care providers across the continuum of care must be aware of as they determine whether, and to what extent, to participate in these models.