CMMI: Expect more value-based care payment models to require health equity plans

If your organization wants to participate in a value-based care payment model, then get ready to create a health equity plan.

Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler said that a requirement for creating such a plan—which outlines how it will treat underserved patient populations—is likely to be a permanent part of payment models going forward. The center included the requirement in the recently launched ACO REACH payment model which is an overhaul of Direct Contracting. 

“You can expect future innovation center models to have features like ACO REACH like requirements for health equity plan,” Fowler said during AHIP’s 2022 National Conference on Health Policy and Government Health Programs on Thursday.

Last month, CMMI announced the ACO REACH model will replace Direct Contracting, which gave partial and full capitation payments to physician groups, starting in 2023. The ACO REACH model is similar to Direct Contracting but includes several requirements for improving health equity, a major priority for the Biden administration. 

The requirements include the creation of a health equity plan that will identify underserved communities and create new initiatives to reduce any health disparities. 

There will also be an adjustment to the benchmarks to reflect health equity, adjusting payments to help entities conduct greater care coordination in underserved areas.

Entities will also have to collect data on beneficiaries' social needs.

So far, ACO REACH is the first model to include a requirement for an equity plan. CMS said in a fact sheet on the model that the plans are vital to track adherence to actions that mitigate health disparities over time. 

CMMI aims to give accountable care organizations part of the model a template to help create the plan. 

Fowler said that the center is also looking at what technical or financial assistance it can offer to entice providers in underserved areas to participate in value-based care.

Her remarks on the equity plan mark one of the first new requirements the administration is likely to employ in future payment models. CMMI put out a strategic refresh last October that featured health equity as a major part in addition to reducing overlap among the payment models. 

She added at AHIP that a lot of the prior CMMI models conflicted with each other, especially for models for specific episodes or bundled payments. While the center still aims to create episode-based models for certain specialties like kidney disease or oncology, it is looking at implementing more total cost of care models.

“We are thinking less about chronic conditions and more about surgical bundles: high-cost, low volume,” Fowler said. She added the center doesn’t “anticipate developing models for every specialty, rather thinking about how specialty care can be part of the greater care coordination.”