CMS doubles down on value-based payments for specialty care: 4 things to know

CMS wants all traditional Medicare beneficiaries and most Medicaid beneficiaries in accountable care organizations by 2030. In a strategy report published Nov. 7, CMS detailed its plans to reach this goal. 

Here are four things to know about how the agency plans to transform payments for specialty care over the short and long term.

1. CMS plans to improve transparency for specialist data and quality measures. 

In the short term, the agency said it will enhance data and dashboards for specialist performance metrics. This will allow participating providers to compare costs and quality. 

2. The agency will ramp up its bundled-payment models. 

The optional Bundled Payments for Care Improvement Advanced Model, launched in 2018, holds participating providers accountable for 90-day windows of care. CMS said it will extend this model through 2025 and add a program focused on bundled payments for oncology care. In the long term, the agency plans to test a mandatory bundled-payments model. 

3. CMS wants to improve primary and specialty care coordination. 

The agency wants to test e-consult features and enhanced referrals to reduce wait times for specialty care. In the long term, it will test the potential for financial targets for high-volume specialties. 

4. The agency plans to create financial incentives for accountable care organizations to manage specialty care. 

In the long term, the agency wants to use incentives to reduce emergency room visits and low-value services. For hospital and physician affiliated accountable care organizations, CMS said it will explore condition and procedure spending targets. 

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