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New Vision of CMS Innovation Center Aligns With ACP Priorities for Payment Systems

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In new strategy paper, CMS says Innovation Center will evaluate aspects of proposed payment systems including equity, care delivery transformation, patient outcomes

Nov 5, 2021 (ACP) – The Centers for Medicare & Medicaid Services Innovation Center, devoted to finding better ways to reimburse medical professionals, is embracing a new vision for the future that emphasizes broader metrics of success.

CMS detailed this new vision in a strategy paper released at the end of October. ACP looks forward to beneficial changes going forward. “Overall, this strategy refresh is in line with what ACP has been requesting for some time,” said Shari Erickson, ACP vice president for governmental affairs and medical practice.

As Erickson explained, the Innovation Center was created as part of the Affordable Care Act as a division within CMS that would test payment models and implement them without needing approval from Congress. “The idea was that the center would allow more testing of models and quicker advancement,” she said, under the rules that “payment systems must improve quality while either maintaining or reducing cost, or they must reduce cost while maintaining or improving quality.”

From the ACP point of view, payment systems within primary care have remained problematic. Last year, ACP released its Vision for the U.S. Health Care System, which addressed delivery and payment system reform. It stated that “poorly designed value-based payment models have the potential to exacerbate health inequities, particularly models that feature patient cost-sharing or those that are available only in certain, typically more urban, geographic regions. Practices and health systems that care for vulnerable patient populations must be supported rather than penalized.”

In its new incarnation, the Innovation Center will evaluate more aspects of proposed payment systems such as equity, care delivery transformation, patient outcomes and market characteristics. “These are broader metrics that will allow the center to think more innovatively than what's laid out in the statutory criteria,” Erickson said. “It's an important change.”

ACP is especially pleased by the focus on equity – a top priority of the College. “CMS is specifically talking about understanding barriers in value-based models for certain populations and the physicians who treat them,” Erickson said. “They're taking a much more deliberative approach.”

Primary care physicians, of course, are crucial to underserved populations, and more support for internists is a proven way to help provide better outcomes at lower cost.

In addition, CMS wants to reduce complexity in the models, streamline participation requirements and reduce administrative burden. “We're thrilled that CMS is being so responsive to ACP's advocacy in support of moving their models in this direction and thinking more broadly and deliberately about the criteria they use,” Erickson said.

ACP will be watching carefully to make sure any new models increase quality and access without imposing undue burdens on physicians and other medical professionals—and that physicians are not pushed into mandatory models too soon. For now, ACP members should keep an eye out for new payment models and reforms of existing models, Erickson said. “We'll be monitoring the models too, and we'll keep members informed about new opportunities that may come along,” she added.

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Back to the November 5, 2021 issue of ACP Advocate