The top officials at the federal Centers for Medicare and Medicaid Services (CMS) on Tuesday, Jan. 11, made a major public statement regarding the goal of moving the healthcare system towards health equity, and a major component of that statement focused on leveraging Medicare’s value-based programs, particularly those focused on accountable care organizations (ACOs) to help drive change.
Writing in Health Affairs Forefront (formerly the Health Affairs Blog), Meena Seshamani, M.D., Ph.D., Elizabeth Fowler, Ph.D., J.D., and Chiquita Brooks-LaSure wrote of their desire to move forward into health equity, in their article, entitled “Building On The CMS Strategic Vision: Working Together For a Stronger Medicare.” Brooks-LaSure is CMS Administrator; Fowler is Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation, called the CMS Innovation Center); and Seshamani is Deputy Administrator and Director at CMS. In the first paragraphs of their article, the three senior leaders write that “[W]e believe that Medicare can contribute to the meaningful, sustainable changes necessary in our health system to put the person at the center of care. Our goals for Medicare mirror Administrator Chiquita Brooks-LaSure’s vision for CMS writ large: advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and the sustainability of the Medicare trust funds. In this piece, we describe how we are furthering these goals and available opportunities to better align and partner across the health care system.”
The senior administrators state very clearly their intentions around health equity, writing that “Medicare will advance health equity by addressing the health disparities that underlie our health system. As women of color who have dedicated our careers to improving health care in the U.S., we know that these disparities have been especially magnified during the COVID-19 pandemic and have put an enormous strain on families and individuals. We must look at everything we do through the lens of health equity, because when the system doesn’t work, it’s those individuals with complex health and social needs who fall through the cracks.”
Indeed, they write, “Building off the Health Equity Plan for Medicare that will soon be refreshed, our approach to advancing health equity is two-fold: improve operations and implement policies that address inequities. For operations, this entails promoting accessibility to health care services (including technology and devices), ensuring that materials developed for people with Medicare are easy to understand, implementing National Standards for Culturally and Linguistically Appropriate Services (e.g., making public-facing materials available in more languages), and expanding data collection, reporting, and analysis to identify disparities and track improvements.” In fact, they write, “Medicare’s enhanced payment policies will improve access to services for individuals who are at risk of multiple chronic conditions and adverse outcomes and who experience social risk factors that impact their health outside of the four walls of their provider’s office. Overall, we will help those who live in rural areas; cannot afford broadband access; lack access to reliable transportation; have increased risk of COVID-19 infection due to disability, ESRD, or other chronic health conditions; or may experience other barriers to accessing the care they need.”
Meanwhile, for the leaders of patient care organizations already involved in value-based contracting, or planning to become involved in them soon, the middle section of the three administrators’ article will be clarifying. They write that, “Over the last decade, Medicare accelerated participation in value-based care—those models that reward better care, smarter spending, and improved outcomes. In 2020, the Medicare Shared Savings Program, established by the Affordable Care Act, saved Medicare approximately $1.9 billion, marking the fourth consecutive year of net savings, while the participating ACOs maintained high ratings for quality of care. The promise of these care models has become even more evident during the pandemic. Many ACOs, including ACOs participating in the Medicare Shared Savings Program and the Next Generation ACO model, invested in care managers and community health workers who provided critical support to communities struggling to stay healthy. They were able to work quickly to transition to telehealth and continue to provide needed access to care; they provide the team-based services needed to address the full spectrum of issues arising from the pandemic, ranging from community prevention and health-related social needs to end-of-life support for patients, their families, and caregivers. They’ve shown us that better care coordination, providing care not just within the four walls of a hospital, but across the unique experiences of a person, is key to keeping people healthy.”
And, they state, “Building on this foundation, we are working across CMS to enhance the movement towards value-based, high-quality care and to ensure that we are all rowing in the same direction so that 100 percent of people with Original Medicare will be in a care relationship with accountability for quality and total cost of care by 2030. We know that when value-based care programs are not aligned, it can be confusing and counter-productive for providers who see patients across a spectrum of payers, and it can create unnecessary confusion for people with Medicare who stand to benefit from the improvements in quality, support in managing health and social needs, and coordination across health care providers.”
Further, they write, “Thus, a key part of our strategy will be aligning and coordinating the care models in both Original Medicare and Medicare Advantage. The Center for Medicare is working with the CMS Innovation Center, as part of the Innovation Center’s Strategy Refresh, to align accountable care initiatives and to use the Innovation Center’s authority to test innovative payment and service delivery models that, if successful, could be scaled into the Medicare Shared Savings Program and made available for more people with Medicare.”
And, they state, “Additionally, the Center for Medicare, Center for Clinical Standards and Quality, and the Innovation Center are working together to help clinicians who are a part of the Quality Payment Program—both primary care and specialists—continue to drive towards value-based, high-quality care. We must also leverage stakeholder engagement, for example through listening sessions and our communications channels, so that people on Medicare and providers, including specialists, better understand these care models and can provide more input into how they are implemented. We must also continue to build our shared learning collaboratives so we can encourage innovation and transformation in care delivery and evaluate and harness lessons learned.”
The remaining two paragraphs in the article focus on the topics of “Promoting Affordability And Sustainability” and “Engaging Our Partners And The Communities We Serve.” Under the former heading, they promote the Build Back Better Act supported by the Biden administration and moving through Congress right now, noting that “The Build Back Better Act, if enacted, will give Medicare stronger tools to address the rising cost of prescription drugs by allowing Medicare to negotiate the prices of high-cost medications”; and, separately, that “We are increasing transparency regarding hospital prices so that people can know what hospitals charge for the items and services they provide.” And under the latter heading, they write that “All of this work has a common theme: we must work with our partners to put people with Medicare at the center of all that we do. Over the past several months, we have met with numerous stakeholders to listen to their perspectives on where we can work together to drive meaningful change in the health care system. We want to hear ideas on how we can advance health equity, expand access, drive high-quality, person-centered care, and promote affordability and sustainability in the Medicare program. We know that doing so requires deep collaboration across the many sectors that touch peoples’ lives. We are committed to ensuring we integrate the perspectives of the communities that Medicare serves, as well as the providers and health plans that deliver health care, into our policies.”
The entire article can be accessed here.
NAACOS expresses support for the statement
The publication of that article led to an immediate statement of support from NAACOS, the Washington, D.C.-based National Association of ACOs. In a press release posted to NAACOs’ website on Wednesday, Jan. 12, Clif Gaus, Sc.D., NAACOS’s president and CEO stated that “Leaders at the Centers for Medicare & Medicaid Services (CMS) this week published a Health Affairs Forefront Blog reiterating their vision for a stronger Medicare. Among the goals outlined was to leverage accountable care models to create more affordable, higher quality care. This accentuates the CMS Innovation Center’s recent Strategy Refresh to have every Medicare beneficiary in a relationship with a provider accountable for their quality and total cost of care by 2030. NAACOS supports these CMS goals, including bringing more patients into accountable care models. Data are clear that ACOs help lower Medicare’s rate of spending and improve quality of care. Supporting ACOs, including increasing incentives for participation and offering more tools to improve care, is fundamental to building a stronger Medicare. Last year, NAACOS outlined numerous ways CMS can advance these policies, and we stand ready to help CMS implement these ideas. Additionally, ACOs remain well positioned to advance health equity, another administrative priority, given their accountability to patients’ total cost of care. NAACOS published separate position papers last year offering recommendations on ways to leverage ACOs to advance health equity. We thank CMS for its leadership on these important issues.”
