The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation has announced that it will take a new approach to developing and testing new models of health care delivery – an approach designed to be more MAHA-oriented.
The Innovation Center intends to place a greater emphasis on disease and chronic condition prevention built around what it calls “three interrelated pillars:” promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition. The agency says it “…will focus on models that show the greatest promise for generating savings and improving quality.”
Specifically, the Innovation Center intends to ensure that its test models are:
- fiscally sound and have a pathway to certification
- prioritize high-value care and services and establish incentives to reduce unnecessary utilization
- have downside financial risk and require providers, not just conveners, to assume some of the financial risk
- move Medicare and Medicaid beneficiaries into accountable care arrangements with providers that assume global downside financial risk
- reduce the role of state government in rate-setting for services
- refine and simplify benchmarking methodology
- ensure that “… funds reach those most in need through proper and non-discriminatory provision of funds for health care services”
Work has already begun with the cancellation of two models – the Medicare $2 Drug List and the Accelerating Clinical Evidence demonstration – before they even began and the announced termination of four more at the end of the year: the Maryland Total Cost of Care, Primary Care First, End-Stage Renal Disease Treatment Choices and Making Care Primary.
During a webinar last week, Innovation Center officials explained that they will be proposing changes in existing models and proposing new models, encouraging participation from providers in rural areas and home-based providers, increasing patient choices, and introducing site-neutral cost-sharing. They also said they will hold listening sessions in the coming months to announce changes in existing models.
Learn more about the agency’s plans from this CMS Innovation Center announcement; this CMS news release; the white paper “CMS Innovation Center Strategy to Make America Healthy Again;” and this FAQ. For additional insight, see the Fierce Healthcare article “Chronic disease prevention a pillar of new MAHA-ified CMS Innovation Center strategy;” the Healthcare Dive report “CMMI revamps strategy to focus on disease prevention, cost savings;” and the Becker’s Payer Issues article “CMS’ new Medicaid, Medicare innovation strategy: 8 notes for payers.”
