Medicare, Medicaid innovation center lays out ambitious agenda for next decade

The federal agency responsible for developing new health care payment models wants every fee-for-service Medicare beneficiary to be getting care from a provider who’s part of an accountable care organization by 2030.

That goal is laid out in a recent white paper from the Center for Medicare and Medicaid Innovation (CMMI), “Driving Health System Transformation—A Strategy for the CMS Innovation Center’s Second Decade.”

“This goal would not only aim to have all beneficiaries in value-based care arrangements, but for them to be in care arrangements where their needs are holistically assessed and their care is coordinated within a broader total cost of care system,” the paper states.

CMMI was established in 2010 as part of the Affordable Care Act to help transition Medicare and Medicaid—and through them, the rest of the U.S. health care system—from relying primarily on fee-for-service payments to value-based care models. CMMI says the white paper is intended as a “strategy refresh” that will include a greater focus on keeping patients healthy and independent, and helping providers coordinate care seamlessly across different settings.

The paper outlines five strategic objectives for achieving these goals, including:

• Increasing the number of patients in a provider relationship that includes accountability for quality and total cost of care—including the objective of having every Medicare fee-for-service beneficiary in an accountable care relationship by 2030.
• Embedding health equity in every aspect of CMMI models with an increased focus on historically underserved populations. New models will include patients from these groups as well as safety net providers, and will require participants to report demographic data on their beneficiaries and on social determinants of health
• Supporting care innovations by enabling integrated, person-centered care, which the paper defines as “integrating individuals’ clinical needs across providers and settings, as well as addressing their social needs.” It cites behavioral health, palliative care and care for patients with complex needs as examples of areas that can be better integrated with primary care
• Improving access to health care by addressing affordability issues. The paper notes that while health spending growth was slower in 2010-2019 than the previous decade, its continuing rise remains unsustainable for governments and individual households. Consequently, “affordability is an important consideration in achieving the Innovation Center’s vision of driving broad system transformation.”
• Aligning health care priorities and policies within CMS itself and with outside stakeholders such as providers, commercial payers, states, and beneficiaries with the goals of improving quality, achieving equitable outcomes and reducing costs

During the next decade, the paper says, CMMI will use these objectives along with other metrics to guide revisions to existing payment models and developing a new portfolio of models that can help drive transformation of the health care system.