New CMMI director says value-based care models at 'crossroads'

The new director responsible for overseeing value-based care payment models emphasized that she is not pulling back on the development of new models after some have been delayed or pulled.

“Our commitment to value-based care has never been stronger,” said Liz Fowler, who was appointed a few months ago to lead the Center for Medicare and Medicaid Innovation (CMMI), which oversees demonstrations and models.

But Fowler said during the National Association of ACOs’ spring conference Tuesday that “we need to be honest about the nature of innovation, that not everything is going to be a home run.”

Her remarks come after CMMI pulled the Geographic Direct Contracting Model that aimed to tie value-based care capitated payments to providers based on regional health outcomes. CMMI also has delayed the start dates for the Kidney Care Choices model and several others.

Fowler said the delays come as value-based care is “at a crossroads right now.”

She said the landscape of value-based care models has gotten more complex with some overlapping and providers having to compete over benchmarks and savings.

Evaluations of such models has also gotten harder to do “when models overlap in the same area,” she added.

But the review comes amid a major question in the healthcare industry over how to structure innovation models.

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The Medicare Payment Advisory Commission recently recommended that CMMI develop fewer but more strategic and innovative models to ensure there isn’t as much overlap.

Fowler warns that such a direction change is “easier said than done.”

She said a lot of the work done at CMMI has been aimed at certification of a model to ensure it is a permanent part of Medicare. This approach means that a model could be designed in a certain way and “in my view can be very limiting,” Fowler said, adding that only four models have become a permanent part of Medicare.

“I wonder if we can think about the overall goal being transformation of the system instead of certification or both,” she added.

Fowler laid out several priorities for how CMMI will rethink the development and evaluation of models.

A major priority will be to consider health equity in every stage of CMMI’s models, part of an emphasis the Biden administration has across its healthcare agencies.

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This may include requirements for all new models to collect and report data on race and ethnicity. It could also mean the development and testing of models that directly reduce healthcare disparities.

Another priority is to expand CMMI’s reach beyond just Medicare and into Medicaid as well as engaging with more payers to do a better job of multi-payer alignment.

Fowler emphasized that while the center is reviewing or delaying some models, it may look like “we are pulling back sometimes, but want to make sure that message doesn’t come across that way.”