CMMI's Liz Fowler calls for better approach to educating public, lawmakers on value-based care

The recent scuffle over the Direct Contracting model should push providers and regulators to do a better job of showcasing the importance of value-based care, a top Biden administration official said.

Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler spoke during the National Association of Accountable Care Organizations’ spring meeting in Baltimore on the agency's strategy for improving participation among providers in value-based care. CMMI has set a goal of having every Medicare beneficiary in a value-based care relationship by 2030.

Fowler said that the center has done focus groups on patients’ thoughts on value-based care. 

“The language we are using is really not resonating,” she said. “They don’t know [what] the term accountable care means and don’t fully know better coordination across providers.”

She added that patients with fewer healthcare needs don’t understand the concept of greater care coordination. 

Fowler also remarked on the “immense political pressure” the center faced to completely withdraw the Direct Contracting model, which grants full or partially capitated payments to physicians for meeting spending and quality targets. 

Progressive Democratic lawmakers have criticized the model as an effort to shift Medicare into privatization. Sen. Elizabeth Warren, D-Mass., and members of the House Progressive Caucus called for the model to be withdrawn, noting concerns of private equity groups using the model to buy physician practices.

But CMMI decided instead to overhaul the model to address the concerns, renaming it ACO REACH. The model has new requirements to address health equity and requirements that physicians make up more of the participant’s governing boards.

Fowler admitted that the changes have yet to quell some critics of the model but said that stakeholders can find more ways to engage with lawmakers on the benefits of value-based care models. 

“What resonated most was patient stories, hearing about actual patients served by models who got care and better coordination and outcomes,” she said. “Hearing from actual patients or patient stories was the most powerful.”

Fowler urged providers to reach out to policymakers in their home states and districts to share such stories. 

The remarks come as the Centers for Medicare and Medicaid Services announced it will rely on ACO REACH to incorporate several equity reforms such as the requirement to create an equity plan. CMS also hopes to reform how benchmark payments to ACOs are calculated in an effort to get more providers to participate in value-based care, especially those who care for underserved patients.