Strategic Direction

NEW! Building On CMS's Accountable Care Vision To Improve Care For Medicare Beneficiaries - Health Affairs (July 31, 2023)

  • Authors: Elizabeth Fowler, Douglas Jacobs, Purva Rawal, Meena Seshamani

Episode-Based Payment Request for Information (RFI) - Federal Register

Background on the CMS Innovation Center 2021 Strategy Refresh – Putting All Patients at the Center of Care

Vision: A health system that achieves equitable outcomes through high quality, affordable, person-centered care.

The CMS Innovation Center, having taken stock of lessons learned from its first decade and 50+ models, is charting a path for the next ten years of value-based care -- one that will improve the health system for all patients. 

The result: a strategy refresh that drives our delivery system toward meaningful transformation, including focusing on equity in everything we do, paying for health care based on value to the patient instead of the volume of services provided, and delivering person-centered care that meets people where they are. 

CMS Innovation Center’s Strategic Objectives

CMS Innovation Center 5 Strategic Objectives graphic

Five strategic objectives will guide the CMS Innovation Center’s implementation of its vision.

Drive Accountable Care

Aim: Increase the number of beneficiaries in a care relationship with accountability for quality and total cost of care.

Accountable care reduces fragmentation in patient care and cost by giving providers the incentives and tools to deliver high-quality, coordinated, team-based care. Models should increase the number of beneficiaries in accountable care relationships with providers, such as advanced primary care providers and ACOs. Quality of care and outcome measures should be measures that matter and include patient values and perspective. 

Measuring Progress:

  • All Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
  • The vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.

Advance Health Equity

Aim: Embed health equity in every aspect of CMS Innovation Center models and increase focus on underserved populations.

Equity must be considered in all stages of model design, operation, and evaluation, and aligned with other CMS programs and initiatives. The CMS Innovation Center aims to engage providers who have not previously participated in value-based care and ensure that eligibility criteria and application processes do not inadvertently exclude or disincentivize care for specific populations, including patients in rural and underserved communities. The CMS Innovation Center must understand the current impact of its models across all patients, utilizing patient-level demographic data, standardized social needs data, and tracking data on penetration of models in underserved communities. 

Measuring Progress: 

  • All new models will require participants to collect and report the demographic data of their beneficiaries and, as appropriate, data on social needs and social determinants of health (data would be collected in a manner in which PHI complies with HIPAA and other applicable laws).
  • All new models will include patients from historically underserved populations and safety net providers, such as community health centers and disproportionate share hospitals.
  • Identify areas for reducing inequities at the population level, such as avoidable admissions, and set targets for reducing those inequities.

Support Care Innovations

Aim: Leverage a range of supports that enable integrated, person-centered care - such as actionable, practice-specific data, technology, dissemination of best practices, peer-to-peer learning collaboratives, and payment flexibilities.

The CMS Innovation Center will test approaches to close care gaps and deliver whole-person care by driving progress in areas like integrated care, behavioral health and social determinants of health. Work in this pillar also includes leveraging data, technology, and payment flexibilities to enable care in homes & communities.  

Measuring Progress:

  • Set targets to improve performance of model participants on patient experience measures, such as health and functional status, or a subset of Consumer Assessment of Healthcare Providers and Systems (CAHPS®, a registered trademark of the Agency for Healthcare Research and Quality) measures that assess health promotion and education, shared decision-making, and care coordination.
  • All models will consider or include patient-reported outcomes as part of the performance measurement strategy for the CMS Innovation Center.

Improve Access by Addressing Affordability

Aim: Pursue strategies to address health care prices, affordability, and reduce unnecessary or duplicative care.

The CMS Innovation Center will pursue strategies to address health care prices, affordability, and reduce waste. It seeks to address affordability directly, such as through models that waive cost-sharing for high-value services or focus on moderating drug prices, as well as indirectly, and through models that target low-value care and sources of waste that drive up patient costs and have proven challenging to confront in prior primary care-based models.  

Measuring Progress:

  • Set targets to reduce the percentage of beneficiaries that forego care due to cost by 2030.
  • All models will consider and include opportunities to improve affordability of high-value care for beneficiaries.

Partner to Achieve System Transformation

Aim: Align priorities and policies across CMS and aggressively engage payers, purchasers states, and beneficiaries to improve quality, to achieve equitable outcomes, to reduce health care costs. 

The CMS Innovation Center cannot achieve health transformation alone. It requires working across CMS and the entire federal government, as well as working hand-in-hand with health care teams and payers, purchasers, states, providers, patient advocates and patients. Success hinges on multi-payer alignment on clinical tools, outcome measures, payment, and policy approaches and building the capacity to transform health care. 

Measuring Progress:

  • Where applicable, all new models will make multi-payer alignment available by 2030.
  • All new models will collect and integrate patient perspectives across the life cycle.

Questions and Feedback

Submit questions or feedback on the strategy to CMMIStrategy@cms.hhs.gov. Also, sign up for the CMS Innovation Center listserv to receive regular updates about the CMS Innovation Center, including opportunities to participate in listening sessions about the strategy and updates on model tests.

Evaluations

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Publications

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Additional Information

Where Health Care Innovation is Happening