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QUALITY IMPROVEMENT

CMS Innovation Center sharpens focus on health equity in new strategy refresh

In late October, the Centers for Medicare & Medicaid Services (CMS) released its strategy and vision for the CMS Innovation Center in a white paper, Innovation Center Strategy Refresh, which will inform how value-based care payment models are designed and evaluated over the next decade. Two major goals for this next period of development and transformation for payment and service delivery models in Medicare and Medicaid are decreasing the burden of spending on individuals, households, states, and the federal government; and improving health equity by reducing the impact of health disparities.

To that end, CMS highlighted five strategic objectives:

  • Drive accountable care
  • Advance health equity
  • Support innovation
  • Address affordability
  • Partner to achieve system transformation

These pillars are intended to provide the framework for a health system that achieves equitable outcomes through high-quality, affordable, and person-centered care.

Since the Innovation Center was established as part of the Affordable Care Act in 2010, more than 50 payment models have been created, of which only six were assessed as successfully generating savings for Medicare. However, those years of experience have also brought forth several key lessons that inform the current strategy refresh:

  • Ensure health equity is embedded in every model
  • Streamline the model portfolio to reduce complexity and overlap
  • Use tools to support transformation in care delivery and assist providers in assuming financial risk
  • Design models that consistently ensure broad provider participation
  • Reduce intricacy of financial benchmarks to drive model effectiveness
  • Encourage lasting care delivery transformation

With the defined focus and key lessons, the Innovation Center strategy refresh indicates that CMS will support all beneficiaries’ ability to access providers engaged in care transformation by addressing issues such as implicit bias in model design, implementation, and evaluation. This will be done by reducing selection bias, improving model designs, and engaging diverse providers for participation, especially providers in underserved communities and safety net providers. Accordingly, CMS will launch more Medicaid-focused models going forward.

The drive toward transformation in the coming years will include fewer models with less overlap and more clarity regarding attributes. To support transparency, CMS will make timely, actionable data available to support provider decision-making, as well as give options for payment and regulatory flexibility to model participants. That flexibility will also include a review of existing models with possible revisions to include modifications that address social determinants of health. CMS notes that it will closely collaborate with beneficiaries, providers, and payers during this strategic refresh to achieve success in impact goals.

Cotiviti’s Network Intelligence solution is uniquely positioned to support the delivery of high-quality care that promotes health and reduces costs for members, networks, and the healthcare system. Watch our on-demand demo as we demonstrate Network Intelligence and discuss how to put data into action to incentivize change by:

  • Identifying and reducing low-value care from inefficient and unnecessary services
  • Implementing member steerage strategies
  • Enabling payer and provider collaboration in high-value care programs

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WRITTEN BY

Mary Srinivas
Mary Srinivas is senior program manager for consulting and supports Cotiviti’s Quality and Performance solutions, bringing 20 years of healthcare experience to her role. She is responsible for leading the consulting relationship for clients using the Network Intelligence solution, developing insightful recommendations and solutions to meet client needs for understanding value-based performance. She also works to enhance cross-solution use of Cotiviti products.

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