- In a Request for Information posted Wednesday the CMS said it is “setting a new direction” for the Center for Medicare and Medicaid Innovation (CMMI).
- In a Wall Street Journal op-ed, CMS Administrator Seema Verma said the agency “will move away from the assumption that Washington can engineer a more efficient healthcare system from afar — that we should specify the process healthcare providers are required to follow.”
- Providers have had mixed reactions to previous CMMI projects, but the CMS Communication Adviser during President Barack Obama’s administration, Aisling McDonough said on Twitter the request "is a giveaway to the industry to use Medicare for their one gains."
Verma and HHS Secretary Tom Price were expected to lead the CMS away from some alternative payment models they view as too restrictive on providers. In August, the agency canceled some mandatory bundled payment programs and scaled back others. That action and this week’s request for comments show the HHS is looking to make some potentially major changes.
That doesn't mean the new administration is looking to move away from value-based payment models in general. In the op-ed, Verma said the CMS wants to “shift away from a fee-for-service system that reimburses only on volume and move toward a system that holds providers accountable for outcomes and allows them to innovate."
The request asks for input on eight focus areas: increased participation in advanced alternative payment models, consumer-directed care and market-based innovation models, physician specialty models, prescription drug models, Medicare Advantage innovation models, state-based and local innovation, mental and behavioral health models and program integrity.
The request focuses on market competition and provider choice, but also notes the importance of patient-centered care.
As more value-based care payment models are tested, there will be clearer guidance for providers on what might work best for them. The industry response to the CMS request could guide future demonstrations and pilot projects. Providers, however, will also be watching for major changes to existing programs they have invested time and money into implementing.