Is your practice ready for CMS Five Strategic Objectives?

by Michael Jones

The CMS Innovation Center (CMMI) has produced many directives recently, many of which deal with the future of value based care. A 2021 strategy statement summarized the vision of CMMI, with these two statements showing how to measure progress (https://innovation.cms.gov/strategic-direction):

• All Medicare fee-for service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030

• The vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030
  

Further, CMS and the CMMI shared these five larger strategic objectives:

• Drive accountable care

• Advance health equity

• Support innovation

• Address affordability

• Partner to achieve system transformation
  

These areas leave little room for ambiguity, and what you and your practice begin to do now to address these areas will pave the way for your continued success.

What do each of these areas mean though, and what can you do in relation to each of these strategic objectives?

Drive Accountable Care

Aim: “Increase the number of beneficiaries in a care relationship with accountability for quality and total cost of care”

What is your practice doing right now with incentive models for your Original Medicare (MSSP) and Medicare Advantage (MA) patients? Especially at a smaller practice, where you often do not meet size requirements to join a standalone ACO or receive the attention of health plans, you still have options. Seeking out partners with a like minded philosophy for alignment will give you the scale and scope needed to not only prosper through these models, but to better serve your patients using tools that might not otherwise be available to you. Larger practices often are already participating in value based care/shared savings contracts with health plans, and can still benefit from finding a partner for an MSSP ACO. To drive accountable care at your practice no matter the size, learn about the options available to you with ACO and ACO Reach and with your health plan relationships, and make decisions based on data, not on emotions.

Advance Health Equity

Aim: “Embed health equity in every aspect of CMS Innovation Center models and increase focus on underserved populations” 

Awareness and data collection are critical components of success in the massively important area of health equity. Mechanisms in ACO Reach, as well as increased interest among health plans for the Medicare Advantage population, especially with Medicaid, are showing just how important advancing health equity is. Access to data and tracking of data will be the area that differentiates the most successful practices in this area, and what you can do now as a practice leader is to begin collaboration with health plans on health equity and monitor your own data. Understanding social determinants of health, not only to point out opportunity areas, but to truly improve healthcare delivery, is a goal you and your practice can support fully, starting right away.

Support Care Innovations

Aim: “Leverage a range of supports that enable integrated, person-centered care - such as actionable, practice-specific data, technology, dissemination of best practices, and peer-to-peer learning collaboratives, and payment flexibilities”.

Reading the intent of supporting care innovations implies a mindset of “you can’t do this on your own”, both in the data collection and interpretation and learning collaboratives. Many practices are active in third party organizations such as the MGMA or AAFP, and collaboration among primary care, with the objective of advancing knowledge and best practices, will be even more important. Realizing that while your practice could be competing for patients in a geography with one or many similar practices, while you each are not only encouraged, but required to share, will be a change from decades past. Embrace that change early, and lead the way to best position yourself for success to support care innovations.

Improve Access by Addressing Affordability

Aim: “Pursue strategies to address health care prices, affordability, and reduce unnecessary or duplicative care”

While prices and affordability might not be in the scope of the physician practice and will rest on health plans for implementation, practices will absolutely be required to look at reduction of unnecessary or duplicative services. Especially as your practice moves along the spectrum of value based care to the shared savings model and beyond, both with your Original Medicare and your Medicare Advantage patients, your focus on these two areas becomes even more important. Choosing services and partnerships that will both be in the best interest of the patient and the system as a whole are now factors you and your practice team must consider now more than ever when making suggestions and choices for your patients. 

Two specific ways that CMS and the CMMI have identified that will impact affordability, which you should definitely be aware of are:

• “Set targets to reduce the percentage of beneficiaries that forego care due to cost by 2030”

• “All models will consider and include opportunities to improve affordability of high-value care for beneficiaries”
  

Partner to Achieve System Transformation

Aim: “Align priorities and policies across CMS and aggressively engage payers, purchasers states, and beneficiaries to improve quality, to achieve equitable outcomes, and to reduce health care costs”

When CMS uses language such as “aggressively engage payers”, and “multi-payer alignment:, the astute observer will see that the broader goal of collaboration among payers with transparency to achieve outcomes is at the heart of the initiative. Alignment among all parties, from CMS to payers to practices to beneficiaries is a stated goal, and preparing for this collaboration now by developing working relationships with health plans and readily complying with patient data sharing initiatives will establish your basis for success to partner to achieve system transformation. Be prepared to have more access to data in a more consistent manner across payers, combined with more accountability for demonstrated results.

Overall, CMS and the CMMI are taking bold and necessary steps today to prepare for a more financial, collaborative, outcomes-based healthcare delivery system by 2030. Taking steps today to both be aware of and implement changes that address these functional areas will position your practice for maximum success.