Chartis Top Reads – Week of October 24 - October 30, 2021

Our research team breaks down this week’s top healthcare news.


Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.

This Week's Topics

Financial Sustainability

Financial Sustainability

The Buzz This Week

Update on the New Strategic Plan from the Center for Medicare and Medicaid Innovation (CMMI)
The Center for Medicare and Medicaid Innovation (CMMI) released a strategic plan “refresh” last week, reflecting on the first 10 years of the center and laying out a plan for “Advancing System Transformation” over the next decade. In its reflections, the report acknowledges that the past decade was largely spent on designing and piloting a large number of accountable care models. But in studying progress, only six of these models were found to have substantial savings for Medicare, and the sheer number explored and the complexity of many of the models presented a confusing landscape for providers to navigate. The report suggests that aiming for a more streamlined set of effective models will be easier for providers and patients to navigate and understand.

It should be noted that CMMI received some backlash from ACO advocacy groups and providers earlier this year after announcing that its Next Generation ACO Model would end at the close of 2021. Critics acknowledged the tight timeframe in which the Centers for Medicare and Medicaid Services (CMS) had to evaluate the program but disagreed with the formal evaluation’s findings and were disappointed to have the program discontinued.

CMMI’s new strategic plan is centered on the goal of having all Medicare fee-for-service (FFS) beneficiaries in a value-based accountable care relationship by 2030, ensuring that their needs are “holistically assessed” and that their healthcare is coordinated in a broad total cost of care (TCOC) model. Qualifying accountable care models could include advanced primary care, Programs of All-Inclusive Care for the Elderly (PACE), Medicare Advantage (MA) plans, accountable care organizations (ACOs), or other models to be developed.

In 2020, two-thirds of Medicare enrollees were in an accountable model. Taking into account population aging and enrollment growth, an additional 30 million beneficiaries would need to be enrolled in such programs to bring the total to 100 percent by 2030. CMMI’s new plan also sets a goal of having most Medicaid beneficiaries in an accountable model in which providers are responsible for quality and cost of care by 2030.

The plan also has a heavy focus on advancing health equity, requiring all accountable care model entities to include patients from historically underserved populations and to collect and report demographic data on all participants (and, where appropriate, data on social determinants of health). CMMI will use the data reported to help identify areas for reducing health inequities and will set targets for doing so.

Other key areas of focus in the refreshed plan include:

  • Supporting care innovations that address patient experience, care coordination, and health promotion and education.
  • Improving access by addressing affordability.
  • Setting targets to reduce the number of beneficiaries who forego care due to cost.
  • Partnering to achieve all the aforementioned goals, aligning CMMI with state health departments, payors, providers, and beneficiaries.

The new strategic plan has been met with cautious praise from several groups, including the National Association of Accountable Care Organizations and the Primary Care Collaborative, with support for the ambitious goal of enrolling so many in accountable models over the next decade and also a desire to continue to test new and existing models and support ACO formation.


Contributors

Roger A Ray, MD
Chief Physician Executive
[email protected]

Alexandra Schumm
Principal, Vice President of Research
[email protected]

Abigail Arnold
Senior Research Manager
[email protected]


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Chartis Top Reads | Healthcare News | The Chartis Group