The Center for Medicare & Medicaid Innovation (CMMI) will break its own rules to test new models.
New alternative payment models (APM) underperformed during CMMI's first decade. CMMI hopes that a focus on primary-specialty care integration will improve outcomes during its next 10 years.
CMMI's new report includes progress made across five strategic categories and a roadmap to continue advancing each one:
- Drive Accountable Care
- Advance Health Equity
- Support Innovation
- Address Affordability
- Partner to Achieve System Transformation
Prioritizing integration is a highlight of the CMMI report, which—in addition to PCP-specialist coordination—signals a greater focus on behavioral and maternal health, person-centered innovation, and multi-payer APM designs.
Connected care models for better outcomes
In its report, CMMI states: "Moving forward, the Innovation Center will consider providing ACOs with tools to better engage specialists, test ways to better link primary and specialty care upstream in the patient journey, and continue to incentivize better management of inpatient admissions and transitions back to the community for patients."
This could include the use of e-consults, an example of "the data, supports, and tools needed to connect advanced primary and specialty care—before, during, and after acute episodes."
Other CMMI priorities to strengthen PCP-specialty care coordination include recruiting more safety net and Medicaid providers and the new Initiative to Strengthen Primary Health Care to increase federal support.
Healthcare's pre-existing conditions
Referrals are an abiding operational obstacle within the healthcare delivery system—a kind of "pre-existing condition" that impacts how referrals are made, to whom, and how close to real-time they can begin connecting a patient to their next needed level of care.
These challenges impact both the daily practice of medicine and broader imperatives, such as value-based care, and what is healthcare's now quintuple aim: patient experience, population health, and cost, plus a new emphasis on health equity and workforce demands.
Government healthcare agencies have been busy this fall, updating their approach to reflect these factors. CMS launched its strategic vision and priorities in September, with CMMI announcing a strategy refresh less than a month ago after finding that only six of its 50 APMs have generated Medicare savings in the past decade.
Ten years is a long time for what's broken to stay broken. Conversely, what's broken is so deeply entrenched, it cannot be fixed overnight. For these reasons, CMMI states it will depart from its typical rules to allow more time to test new advanced primary care models and achieve results.
The agency may take this approach with other models as well, noting the importance of "longitudinal accountable care" as a focus area as well as " testing mechanisms to deliver integrated-whole person care, especially by increasing access to coordinated and high-value specialty care; and supporting providers on the value-based care journey by driving meaningful multi-payer alignment and providing data to support patients at the point of care, and across settings."
Laura Beerman is a contributing writer for HealthLeaders.
An emphasis on primary-specialty care integration marks a new report from CMMI.
This emphasis signals a new willingness by the agency to test care models over a longer period of time.
The November progress update comes just one month after CMMI's October strategy refresh and includes additional integration priorities.