CMS Announces New Flexibilities Around Innovation Models

June 4, 2020
Seema Verma wrote in a blog post this week that CMMI models “must be adjustable to address the uniqueness of the current situation.”

The Center for Medicare and Medicaid Innovation (CMMI) will be providing new flexibilities and adjustments to current and future value-based care models to address the COVID-19 pandemic, CMS Administrator Seema Verma wrote in a Health Affairs blog this week.

Created under the Obama administration, CMMI is charged with piloting, testing and evaluating alternative payment models—such as bundled payment models, for example—with the intent of increasing quality and efficiency, while reducing program expenditures under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Verma wrote in her post that the CMMI “models are even more important in a pandemic, to provide consistent, predictable income that keeps the focus on disease prevention.” However, in response to the health crisis, the models “must be adjustable to address the uniqueness of the current situation.” As such, in response to COVID-19, CMS is providing new flexibilities and adjustments to current and future CMMI models to address the emergency.

The federal agency released a new chart outlining the models and the changes that have been made. The Next Generation ACO model, for instance, has been extended through December 2021. The same extension has been granted for the Medicare ACO Track 1 + model, on a voluntary basis. Meanwhile, CMS is offering a second round of applications to participate in the Direct Contracting model starting in 2022, and is delaying the start of the first performance period for the initial cohort to April 1, 2021. CMS said it used the following principles to determine which changes were appropriate:

  •     Utilize flexibilities that already exist in current model design
  •     Continue sufficient financial incentives that encourage higher-quality outcomes
  •     Ensure equity and consistency across models
  •     Align as much as possible with national value-based and quality payment programs
  •     Minimize risk to model participants, the Medicaid program, and the Medicare Trust Funds
  •     Limit delays in new model implementation, while providing additional opportunities for participation in new models
  •     Minimize reporting burden
  •     Complement and build off the new CMS COVID-19 Public Health Emergency flexibilities as outlined in regulation and waivers

In a statement, the Charlotte-based Premier applauded the extensions, noting, “These changes provide urgently needed relief for healthcare providers in advanced alternative payment models (APMs) that bear a significant amount of risk.” The statement from Blair Childs, senior vice president, public affairs, at Premier, continued, “We’ve found that providers participating in alternative payment models were better prepared and able to ramp up care management, call centers and remote/home monitoring and other capabilities to respond to COVID-19. These changes will enable participants to stay in the models so that we do not loose progress in the movement to value-based care. We look forward to continuing to work with CMS as more details of these new policies are developed and to ensure the long-term success of these models.”

Meanwhile, in regard to the Next Generation ACO program, the National Association of Accountable Care Organizations (NAACOS), an organization which has been pushing for the Next Gen ACO program extension, Clif Gaus, Sc.D., president and CEO of NAACOS, said the move “offers Next Gen ACOs an Advanced Alternative Payment Model to participate in for 2021. NAACOS hopes the additional year will give CMS more data on which to make the Next Gen model permanent. We are also pleased to see CMS release details on how the agency will adjust the program to protect ACOs from losses spurred by the COVID-19 pandemic.”

Regarding Direct Contracting, NAACOs said its glad to see CMS offer a second round of applications to participate in the Direct Contracting Model starting in 2022. Its statement continued, “While more clarity was offered with the announced April 2021 start date, ACOs and other interested participants need to see more detail about the model’s financial aspects, such as how spending benchmarks will be set and how populations will be risk adjusted. CMS hasn’t released other information such as when an application period for the April 2021 start date will take place. Direct Contracting offers the next step in accountable care models, and NAACOS looks forward to continuing to work with CMS on its development and implementation.”