5 Fast Facts: How CMS is Changing Health Care Payment

Help Spread the Word!: 

At the Centers for Medicare & Medicaid Services’ recent Health Care Payment Learning and Action Network (LAN) Spring Summit, more than 400 attendees from all sectors of the health care industry joined forces to accelerate the transformation already underway to pay providers for quality and outcomes, rather than volume. Alternative Payment Models are the LAN’s focus; these include bundled payments for clinical episodes like maternity, and Accountable Care Organizations that share in savings from delivering more efficient, effective care.

Here are five fast facts from the Summit, which took place in Tysons Corner, Virginia:

  1. CMS is fully committed to changing health care payment. Deputy Administrator Patrick Conway set the tone early, noting that Health Care Payment LAN workgroups have already issued recommendations in key areas that include patient attribution, financial benchmarking and performance measurement for population-based payment. We now are at the critical juncture of turning to action,” he said. If we don’t, it will be an opportunity lost that will hurt patients and families.”
  2. Industry leaders have created a powerful framework. Insurers, provider organizations and others worked with CMS to create a framework for defining and categorizing Alternative Payment Models (APMs). Category 1 encompasses fee-for-service payment with no link to quality or value, while Category 4 payment depends on keeping a population of patients healthy. This framework also is a continuum; CMS expects payment to shift toward Categories 3 and 4 over time.
  3. Real change requires setting goals and sharing progress. Darren DeWalt, Director of the Center for Medicare and Medicaid Innovation’s Learning and Diffusion Group, stressed the importance of accountability and transparency in implementing APMs. This is important to moving forward all of the providers in a community. It sends a strong message to your partners that they can change (how they deliver care and are paid), because you have changed your model.”
  4. QIN-QIOs, PTNs and others are ready to help providers make the transition. A plenary session highlighted QIN-QIOs and Practice Transformation Networks that are preparing thousands of clinicians for successful participation in APMs by building skills like workflow redesign, performance improvement and electronic health record optimization. Quality Improvement and Innovation Group Director Dennis Wagner encouraged providers to take advantage of the capacity-building expertise that CMS’ quality networks offer at the front lines of health care delivery.
  5. Read the MACRA proposed rule to learn more. The Federal Register may not be not light reading; however, it provides an opportunity to comment on CMS’ draft payment regulations before they are finalized. (MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015, a bill to modernize how CMS reimburses physicians and other clinicians, and which passed with broad bipartisan support). The proposed rule was released April 27, 2016, and the comment period closes June 26