CMMI director says agency won't force all providers to assume risk
Center for Medicaid and Medicare Innovation Director Adam Boehler said Thursday the industry should expect CMS to get into a "rhythm of announcements" on value-based care and other CMMI initiatives moving forward. He spoke at an Alliance for Health Policy breakfast, his first official sit-down with Washington media in his new role.
Boehler, wrapping up his fourth month as CMMI director and his first as senior advisor for value-based transformation and innovation to HHS Secretary Alex Azar, laid out four focus areas for the administration: empowering the patient as a consumer, making physicians accountable for outcomes, paying for outcomes across the board and preventing negative health outcomes.
However, Boehler made sure to stress that the move to value-based care would be slow and deliberate — and implied it would remain voluntary when it comes to physician-assumed risk. "Be what you are," Boehler said, but added "we want to create that avenue" for those practices that are interested in taking on more risk.
The industry search for predictability amid a regulatory landscape in flux is understandable, and may be assuaged, in part, by Boehler's words. As the ex-Landmark Health CEO discussed how to make physicians accountable for overall outcomes without increasing burden, he maintained that risk would not be forced on physicians or practices that do not want it.
Yet provider unwillingness to assume risk is a major challenge in the push toward value-based care.
An August analysis of 2016 data showed that CMS' Next Generation ACOs, which carry the most risk of any current ACO model, saved Medicare roughly $62 million without sacrificing quality of care.
Still, a May survey found that nearly three-fourths of accountable care organizations would leave the Medicare Shared Savings Program if they were forced to assume downside risk even as independent experts push providers to put more on the line. Though participating ACOs had a plethora of reasons for avoiding the financial gamble, the three top drivers were the amount of risk assumed, the possibility of unforeseen changes via shifting CMS rules and the desire for more predictable financial projections.
At the same time, CMS has seemed to be doubling down on the pressure. Earlier this month, the agency proposed an MSSP overhaul that would force participating ACOs to take on financial risk earlier than expected — after one year for existing ACOs and after two years for new ones, opposed to the prior six.
Top brass at CMS have focused on a need for moving beyond traditional payment models.
"It's time for the program to evolve," Verma told reporters after the MSSP announcement. "What the data tells us is that ACOs taking two-sided risk are delivering better results.
CMS additionally proposed to phase out its no-risk model by 2020, giving participating organizations two stark options: take on risk or take an exit.
At the reporters-only event Thursday, Boehler also discussed the focus from CMMI and CMS on allowing the consumer to drive the system through transparent and interoperable initiatives to create a competitive marketplace and incentivize patients to make the best choices for themselves.
The agency is similarly focused on reducing burden for physicians, Boehler said. He pointed to superfluous quality measures as an example of an unnecessary practice and argued that they, along with other antiquated processes, should be replaced with "next generation" measures such as artificial intelligence in EHR data.
Regarding what the government can do to lower costs, Boehler cited the broken payment system. "Most of the time you see something wrong in the healthcare system, it’s because we're paying the wrong way," he said. In Boehler's view, a lot of those erroneous practices made sense 30 years ago, but need to be phased out now."
He cited ambulance paying practices as an example. If you call 911, the ambulance provider isn't paid unless it takes you to the hospital — so, the first responders' priorities may not always match that of the patient.
Finally, Boehler brought up CMMI's commitment to preventable care and un-siloing the country's health system. Regarding housing, social services, food stamps and government social programs, he said, "If you were going to design the American health system today, from scratch, you wouldn't silo those. You'd look at the whole system."
- Healthcare Dive Next-Gen ACOs saved $62M in first reporting year, CMS says
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