Verma: Trump administration mulling mandatory payment models 

Centers for Medicare & Medicaid Services Administrator Seema Verma said Thursday that while the Trump administration has focused on voluntary payment models, that is likely to change. 

During a speech at the National Association of ACOs conference in Baltimore on Thursday, Verma said launching mandatory payment models is crucial to avoid selection effects that can skew data on how well they’re working. 

To date, CMS has launched new voluntary bundled payments, primary care models, updates to accountable care, payment models for drugs and other value-based arrangements. Verma didn't specify in what area the agency was developing new mandatory models.

In a voluntary model, only the providers who see that they may benefit financially are likely to join on their own, which can limit the participation pool, the CMS chief said. 

“Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative,” Verma said. 

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Verma also highlighted the status of CMS’ overhauled version of the Medicare Shared Savings program, called Pathways to Success. The agency updated the most popular accountable care organization (ACO) program to push providers into taking on greater risk more quickly. 

Despite concern that potential participants would ditch the ACO model if forced to take on greater risk—about a third of respondents to a recent survey said they would exit the model in its final form—Verma said 90% of existing ACO contracts were renewed at the end of last year. 

Of those, 85% applied to move into the Pathways program, Verma said. In addition, 38% of these ACOs applied for the highest risk-bearing track, which would classify them as advanced alternative payment models (APMs). 

By comparison, just 19% of ACOs involve two-sided risk, and just 10% of clinicians are enrolled in an advanced APM, Verma said. 

“We are deeply invested in the ACO program, and to the value-based transformation overall,” Verma said. “I am excited to see the models we are rolling out.” 

RELATED: Why hospital associations are dipping their toes into state-based Medicare ACOs 

Verma also touched on the "Medicare for All" debate in her speech and said the Trump administration is focused on “keeping what works and fixing what doesn’t” rather than overhauling the system top to bottom. 

She said she’s “not here to protect the status quo,” but value-based payments and similar changes are more effective ways to address issues within healthcare. 

“I believe reforms are urgently needed in healthcare, as the system isn’t sustainable,” Verma said. “But instead of doubling down on government control, we need to understand and address the drivers of healthcare spending.”