CMS offers flexibility for value-based care models affected by COVID-19

Seema Verma interviewed by Steve Forbes at Forbes Healthcare Summit
Centers for Medicare & Medicaid Services Administrator Seema Verma outlined a series of changes and extensions for value-based care payment models to help providers wracked by the COVID-19 pandemic. (Forbes/GettyImages)

The Trump administration outlined a series of major changes to value-based care payment models intended to address problems created by the COVID-19 pandemic, including delaying the start of a new accountable care organization (ACO) model.

The Centers for Medicare & Medicaid Services outlined the changes Wednesday (PDF) in a bid to ensure participation in the payment models as providers struggle financially under the pandemic.

“Our actions reflect our commitment to being good partners with providers who commit to value-based care,” CMS Administrator Seema Verma wrote in a blog post on the journal Health Affairs. “We want our partners to know that we’ll make adjustments when emergencies such as pandemics arise.”

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The changes include:

  • Delaying the start date for the new Direct Contracting model from Jan. 1 to April 1, 2021. The agency will adjust any quality benchmarks to reflect the new performance period. CMS also will start an application cycle during 2021 for a second cohort to launch on Jan. 1, 2022. Multiple groups have complained that CMS hasn’t given enough details to ACOs on the contours of the model.
  • Extending the Next-Gen ACO model through Dec. 2021. The Next-Gen model calls on ACOs to take on more downside risk than in the Medicare Shared Savings Program (MSSP). The model sunsets at the end of this year, and CMS had privately told participants that it wouldn’t be back. For the 2020 performance year, CMS will reduce shared losses for Next-Gen ACOs during the months of the COVID-19 public health emergency. The agency also canceled a quality audit for 2019 and caps the ACOs’ gross savings upside potential at 5%.
  • Extending the Oncology Care Model, which centers on value-based care payment arrangements in oncology practices for an additional year through June 2022. The agency also gives practices the option to forgo upside and downside risk performance for any periods of time affected by COVID-19. Practices that continue to participate in one- or two-sided risk will have any COVID-19 episodes removed from reconciliation for the performance periods.
  • Delaying start of the serious illness component of the Primary Care First model until April 1, 2021. The Primary Care First only component still starts on Jan. 1, 2021.
  • Removing the downside risk for the Comprehensive Care for Joint Replacement Model for any episodes from Jan. 31 through the termination of the COVID-19 emergency period. CMS also extends the fifth performance year through March 2021.
  • Giving participants in the Bundled Payments for Care Improvement Advanced an option to eliminate upside or downside risks. Participants that choose to continue with two-sided risk will have COVID-19 episodes of care excluded.
  • Extending the Comprehensive ESRD Care Model through March 31, 2021. CMS will also reduce 2020 downside risk by reducing shared losses by the proportion of months throughout the public health emergency period. CMS also caps gross savings at 5% and removes the 2020 financial guarantee requirement.
  • Removing episodes of care for the treatment of COVID-19 for the Medicare ACO Track 1+ Model. The agency will also give participants a voluntary election to extend the agreement for one year through December 2021.
  • Delays first performance period for the Kidney Care Choices to April 1, 2021. CMS also creates an application cycle during 2021 for a second cohort to launch in January 2022.

CMS has previously given regulatory relief for the MSSP and post-acute care programs such as the long-term care quality program.

The National Association of Accountable Care Organizations (NAACOS) praised the extension of the Next-Gen program in a statement.

"Today’s move offers Next Gen ACOs an Advanced Alternative Payment Model to participate in for 2021," the group said. "NAACOS hopes the additional year will give CMS more data on which to make the Next Gen model permanent."

"We are also pleased to see CMS release details on how the agency will adjust the program to protect ACOs from losses spurred by the COVID-19 pandemic," NAACOS added.

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