Skip to main content

What to expect from CMS’ second decade of APM programs

CMS has introduced more than 50 innovative care delivery models designed to drive health system transformation over the last decade. Only six of those produced significant savings; of those, only four met the requirements to be expanded.

As the second 10-year period of the program gets underway, which includes $10 billion in new funding, CMS’ Center for Medicare and Medicaid Innovation is considering numerous changes to improve the overall success of these programs and, in turn, drive overall gains in care outcomes and health equity. When evaluating what has worked in the past and what changes are needed moving forward, it is important to review what success looks like for Alternative Payment Model programs. 

CMMI relies on three benchmarks to measure levels of success:

  1. The gold standard: improving quality of care while simultaneously reducing expenditures.
  2. Improving quality of care without impacting expenditures.
  3. Reducing expenditures without impacting quality of care.

To better meet these metrics, major adjustments must be made moving forward to enable health systems to improve the value for the communities. CMS has identified the hurdles involved and has proposed next steps, including steps to 1) simplify programs, 2) increase health equity, and 3) drive further provider participation. 

Here is more on the key changes CMS must make to advance these goals:

  1. Fewer and more parsimonious models that simplify overlap issues. Complex payment policies and model overlap rules can make participation difficult due to conflicting or opposing incentives and rules, high administrative burden and prohibitive investments. To address this, CMS must make APM requirements as transparent and easy to understand as possible, while integrating with other APMs and value-based care programs. This will simplify scaling and integration into broader CMS operations for participants.
  2. An emphasis on health equity must be considered with any new model designs. Currently, APMs do not reflect the full diversity of beneficiaries represented in Medicare and Medicaid, and their success has not been assessed across diverse populations. For future models, CMMI is working to understand barriers to participation, reducing implicit bias in model design and implementation, and better analyzing the impact of its models across more diverse populations.
  3. CMS must drive additional provider participation and minimize selection bias.  Model participation has been limited and affected by selection bias since providers are able to opt in to models only if they project savings. This can ultimately impact the evaluation of existing models’ success. Selection bias issues can be addressed by reducing risk of participation, especially to those who serve traditionally underserved communities, and adjusting model design to encourage participation.  

Data analytics is the key for future APM participation

As CMMI begins to employ these changes, providers can prepare for and more successfully participate in APMs through emerging digital health options. As the industry continues to digitize, processing data efficiently will become a requirement, rather than an option. A strong data analytics infrastructure can offer an indication of which programs are right for you, measure performance of existing programs and quantify results. 

Comments

Popular posts from this blog

What is the purpose of a Community Health Assessment?

The purpose of a Community Health Assessment goes beyond achieving state requirements or receiving accreditation. If you're a local health department, you may be interested in finding ways to push your CHA data further to more easily identify ways to improve health equity and community outcomes. Focusing only on submission can be counter-productive to the community outcomes you want to achieve. In this blog, we'll give you an overview of the importance of conducting a CHA. Plus, we'll provide you with key information you can use to reset your workflow and rethink your processes. Why you need to complete a Community Health Assessment Certain states require a CHA because it provides a systematic review of a community's health status and essential data and information regarding the health of the community. Specifically, the New York state Department of Health writes, "Community health assessment is a fundamental tool of public health practice. Its aim is to describe

Unlock the Potential of Value-based Payment

A common misconception in healthcare practices: Organizations can quickly reap the benefits of value-based payment transformation. To launch a successful value-based payment program , practices must implement a variety of foundational pieces. It may take time, resources and data before a practice can successfully engage in VBP. In this blog, we'll cover what goes into VBP and its potential benefits. We'll also dig deeper into practice advancement strategies and how they can help you achieve your practice goals. What goes into VBP? Many practices want to implement VBP because of its payment structure and return on investment. Yet, they might not consider how to nurture a successful VBP program in their organization. It starts with a gap analysis regarding people, processes and technologies. It’s important to celebrate what is working well and intervene where improvement can be made. Successful VBP starts with the practice team. There are many perceptions vs. realities that exist