14 Sep Championing the Move to Value-Based Care
With the passage of the Affordable Care Act (ACA), the Medicare program embarked on a significant journey toward a value-based payment and care delivery system. The broad goal was to achieve a transformed system focused on the value of the care received by patients over the volume of services furnished by providers.
The ACA included two major initiatives to promote value-based payment: (1) a new Center for Medicare & Medicaid Innovation to conduct modernized testing and iteration of alternate payment models; and (2) the Medicare Shared Savings Program, a voluntary yet permanent program for providers wishing to participate in Accountable Care Organizations.
Ten years in, value transformation is fundamentally changing the way health care is delivered and paid for – both in Medicare and increasingly in Medicaid and commercial insurance too. Greater incentives to coordinate care and financial performance benchmarks have been designed and refined to make care more efficient, less costly, and with better outcomes. The journey is challenging and the work hard, yet the benefits are paying off.
Through the resources that follow, the Health Care Transformation Task Force explains and amplifies how value-based payment and care delivery is changing our nation’s delivery system for the better. We look forward to continued progress over the next ten years!
CMS Innovation Center Models
Accountable Care Organizations: A Gateway to a Value-Based Delivery System
Value-based payment policies and models, including Accountable Care Organizations, have contributed greatly to bending the cost curve of national health expenditures over the last ten years. ACOs have contributed to slowing the growth in health care costs, have demonstrated improved care coordination and quality, promote the shift to value-based care, increase the use of preventive care, and improve the health care systems’ ability to respond to emergencies.
Success of the Pioneer ACO
The success of the Pioneer ACO demonstration resulted in its certification for permanent inclusion in Medicare. The core of the Pioneer ACO model created a new ACO track under the MSSP program and informed the creation of the Next Generation ACO model.
Impact of the Next Generation ACO Model
Participants in the Next Generation ACO model have demonstrated success in terms of controlling costs for Medicare and improving care for seniors. In the first three years of the program, the Next Generation ACO model produced $358M in net savings through improved care coordination for Medicare beneficiaries. While a perfect value-based payment model has not yet emerged, the alternative to fee-for-service remains an outdated system that is costly, unsustainable and fails to put patients first.
Impact of the Bundled Payments for Care Improvement Advanced Initiative
Bundled payment models play a critical role in the APM ecosystem by engaging specialists on improving quality and reducing costs for specific services or conditions that would be difficult to address through other APM approaches. The Centers for Medicare and Medicaid Services’ decision to iterate on the BPCI Classic model to design the BPCI Advanced model allows providers who invested in episode-based models to continue to pursue their care delivery reform efforts.
Success of the Medicare Diabetes Prevention Program
A major challenge in evaluating prevention programs is the often-lengthy delay between the initial intervention and the full benefits. The demonstrated long-term successes of the diabetes prevention program warrants a renewed discussion within CMS on strategies for evaluating the impacts of CMMI prevention-focused models that extend beyond the model performance period.