CMS’ new Medicaid, Medicare innovation strategy: 8 notes for payers

The Center for Medicare and Medicaid Innovation is laying out a new strategy, including plans to require all alternative payment models to involve downside risk. 

In a May 13 news release, Abe Sutton, director of the CMMI, wrote that the center will action a three-pronged strategy of promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition. 

CMMI pilot programs have “shown promise for supporting preventive care,” Mr. Sutton said, but most models have not met the criteria to be expanded nationwide. 

In March, the CMMI terminated four Medicare payment models early, a move the agency said saved $750 million. 

“We stand at a defining crossroads in American healthcare with an unprecedented opportunity to protect taxpayer dollars and fundamentally reshape how we approach health and wellness by embracing preventive care,” Mr. Sutton said. 

Here are eight things to know about the CMMI’s strategy going forward: 

1. CMMI is designing models to encourage more independent provider practices to participate in value-based payment programs.
   
   
2. The programs’ Medicare Advantage models will be designed to increase “high-value” coverage options, Mr. Sutton wrote. Future models could include testing inferred risk scores or changes to quality measures. The models could also require site-neutral payments in the program to reduce costs.
   
   
3. CMMI will implement standard quality measures, benchmarking and other features where appropriate to reduce administrative burdens on providers participating in models.
   
   
4. The center will require that all alternative payment models require downside risk, Mr. Sutton wrote.
   
   
5. Prevention will be part of “every model” CMMI tests, Mr. Sutton said. Existing CMMI programs will be modified to increase access to preventive care. Future models could include evidence-based alternative medicine and waivers to allow providers to distribute some durable medical equipment that does not meet national coverage determinations.
   
   
6. CMMI is backing global risk and total cost of care models in traditional Medicare, Medicare Advantage and Medicaid. The center is exploring testing specialty-focused longitudinal care in Medicare Advantage and Medicaid, Mr. Sutton wrote. 
   
   
7. Future models will increase beneficiary access to mobile-device applications for disease management.
   
   
8. CMMI will issue waivers designed to create more predictable cost-sharing for certain services, drugs or devices.