The first episode of Enabling Health Value features Elizabeth Fowler, Ph.D., J.D., the Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMMI). As the one of the foremost leaders in the value-based care movement, overseeing the design and experimentation of new innovative payment models in the Medicare, Medicaid, and CHIP programs, she brings unparalleled expertise and insight into transforming healthcare delivery to enhance patient outcomes while containing costs.
CMMI has launched a bold new strategy for achieving equitable outcomes through high quality, affordable, person-centered care. To achieve this vision, the Innovation Center has organized around five objectives: Drive Accountable Care, Advance Health Equity, Support Innovation, Address Affordability, and Partner to Achieve System Transformation. In the next decade, CMMI will apply lessons learned in establishing this strong foundation to lead the way towards broadened and more equitable health system transformation in our country. The ultimate goal is to have all Medicare beneficiaries in a care relationship with accountability for quality and total cost of care by 2030.
Podcast Transcript
01:30 Introduction to Elizabeth Fowler, Ph.D., J.D., is the Deputy Administrator and Director of the CMS Innovation Center.
02:45 Referencing the Innovation Center Strategy Refresh – how is CMMI doing in it national push towards value since announcing its new strategy in 2021?
04:00 CMMI Update on the Five Objectives: 1) Drive Accountable Care, 2) Advance Health Equity, 3) Support Care Innovations, 4) Improve Access by Driving Affordability, 5) Partner to Achieve System Transformation
04:15 CMMI’s Bold Goal for Accountable Care – All Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
04:30 “We are committed to embedding health equity in every aspect of our work.”
04:45 “Affordability includes out-of-pocket costs – not just program costs.” (Example: $35 insulin model in the Inflation Reduction Act)
05:00 Value-Based Multi-Payer Collaboration (Medicare, Medicaid, and Commercial) – the most challenging of all the goals!
05:30 New Updates: Established metrics for each of the five objectives, Specialty Integration Strategy, APM Quality Improvement Pathways, ACO Visioning for Health Equity.
05:00 Six new CMMI Alternative Payment Models have been announced since mid-2023.
06:30 Confusion with the term “value-based care” – how do we explain in plain language what VBC is and how it supports patients and providers?
08:00 The evidence that payment model innovations work!
09:00 The need to engage beneficiaries on the benefits of care coordination and aligned incentives to improve care quality and outcomes.
09:30 CMMI just launched the “Value-Based Care Spotlight” – a new website breaking down the basics of VBC in order to educate both healthcare consumers and professionals alike.
10:30 Patient and Provider Voices — showcasing how value-based care has affected the lives of patients and providers around the country.
11:30 Qualifiers to the recent CBO report on Federal Budgetary Effects of CMMI Activities.
12:45 How CMMI is reexamining its portfolio of APMs to decide which models should be expanded at scale (with actuarial certainty of cost savings at 95%).
14:30 The ‘spillover effect’ of CMMI payment models on the broader healthcare system, including MSSP and Medicare Advantage.
15:15 A pivot away from the “let a thousand flowers bloom” approach to a more coherent APM portfolio strategy.
15:45 CMMI’s role in sharing best practices (e.g. Care Coordination, Team-Based Care, Risk Stratification) and quantifying ‘spillover effect’ of Advanced APMs.
17:30 7X Growth in ACO REACH aligned beneficiaries in three years. $371.5 million in ACO REACH savings in PY 2022.
19:00 ACO REACH has seen a 25% increase in FQHCs and other safety net providers participating in the model.
19:30 ACO REACH Model Features: Upfront Payments to fund infrastructure, Voluntary Alignment, Streamlined Quality Measurement, Special High Needs Track, and Health Equity provisions.
20:30 Recent REACH Improvements: Strengthening the Health Equity Benchmark Adjustment, Enhanced Flexibility for NPs/PAs to deliver Chronic Care Management.
21:00 Stay tuned in the next few months to learn more about the future of ACO REACH! (Currently planned to sunset at end of 2026)
21:30 New Payment Models! — Making Care Primary (MCP) Model and the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model.
23:15 Making Care Primary builds on more than a decade of experience testing advanced primary care models (CPC, CPC+, Primary Care First).
23:45 MCP provides onramp for safety net and small PCP practices (3 tracks), has alignment with state Medicaid programs, and is a longer model (10-year contract period).
24:30 States are the partners with CMS in the new multistate-based AHEAD Model.
25:00 AHEAD restructures all payers in a region, with increased investment in the types of care correlated with improved population health and health equity.
25:30 AHEAD provides statewide accountability for a TCOC approach that includes hospital global budgets and primary care efforts.
26:45 MCP starts in July (currently reviewing provider applications in selected 8 states). CMS is also accepting applications for Cohort 3 of AHEAD.
27:30 How is CMS supporting providers with capital, especially those in the safety net, so they don’t get left behind in value-based care?
30:30 “CMMI has an explicit role to create opportunities and pathways for small, inexperienced, and under-resourced providers to enter into value-based care.”
31:00 New Payment Model! – Transforming Maternal Health (TMaH) Model was developed in response to the profound maternal morbidity and mortality experienced along racial/ethnic lines.
32:30 The White House Blueprint for Addressing the Maternal Health Crisis and how the TMaH Model will support state Medicaid efforts to improve maternal health care.
33:00 “Medicaid covers half of all births in this country. Doing this model in Medicaid made a lot of sense to us.”
34:00 Broadening the maternal health workforce (e.g. doulas, midwifery services, perinatal healthcare workers) and improving data sharing with CBOs.
35:30 New Payment Model! – Innovation in Behavioral Health (IBH) Model has the goal to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder.
36:00 “The unprecedented behavioral health crisis, and the impact is even more significant in Medicare and Medicaid populations.”
37:00 IBH as a glidepath for behavioral health providers to move from FFS to value-based payments.
39:00 “If we are to make progress with our 2030 accountable care goal, we will need better integration of specialty and primary care.” (Whole-person care addresses the full needs of a patient population.)
40:00 Enhancing Specialty Performance Data Transparency (See “Shadow bundles: A big opportunity for MSSP and REACH ACOs”)
40:45 Maintaining Momentum on Acute Episode-Based Bundled Payment Models (BPCI Extension and Move to Mandatory Bundles)
41:45 Incentivizing PCPs and Specialists to Communicate and Coordinate Better (e-Consults, enhanced e-Referrals, establishing financial targets for high volume/high cost specialty care)
42:15 Creating Financial Incentives for Specialists to Affiliate with ACOs (ACO Financial Incentives to better manage specialist care)
44:30 “Payment innovations like accountable care that drive team-based care – where providers can offer better care coordination and more patient-centric care – is the type of care we want for our patients, parents, and grandparents.”
45:00 Parting thoughts of optimism from Liz Fowler on the future of value-based care.