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From Fierce Healthcare

Value-based care payment models that focused on a global budget were home runs in a recent Trump administration review, but bundled payment results were more mixed.

Brad Smith, the head of the Center for Medicare & Medicaid Innovation (CMMI) that oversees value-based care payment models, gave during the National Association of Accountable Care Organizations’ fall conference Tuesday details of the agency’s review of the performance of every model.

Some of the winners were ones that had a “clear thesis” about quality and cost improvements, Smith said.

He pointed to Maryland’s Total Cost of Care model as an example. The model sets a per capita limit on Medicare costs in the state.

“Our belief was that if folks had full global budget for their hospital, and even if that total global budget didn’t increase as fast as they would have [liked] that they would be able to manage it,” Smith said.

He said the model was able to generate savings, meet different quality metrics and decrease hospitalizations. The Centers for Medicare & Medicaid Services predicts the model could save Medicare $1 billion by the end of 2023.

Another example was the home health value-based purchasing model, which gives incentives to home health agencies for higher quality care.

“We had a number of quality metrics, and what we believed is that those quality metrics and incentivizing them was tied to a decrease in hospitalization and that is exactly what we saw,” Smith said.

But some payment models had more mixed results. He pointed to some models that had “incredible amounts of transformation but maybe not either the quality improvement or savings improvements we were hoping to see at this scale.”

One example was bundle payment models that combine payments for physicians, hospitals and other providers into a single amount reflecting the total cost of care.

Another example is the oncology care model that ties payments for items such as chemotherapy and other cancer treatments to financial and quality measures.

While bundled payments and oncology were able to see improvements, there were concerns about whether the benchmarks and tiered savings were structured well enough to make the models successful from a financial perspective.

“Instead of us being in a place to say ‘hey, we are ready to scale this model nationally,’ we are having to go back and say, ‘we saw a lot of good things but didn’t do it exactly the way we thought,’” Smith said.

This is bad for the provider that is hoping the model becomes more lasting and can scale and be sustainable over time, he added.

He hopes that CMMI’s new direct contracting model, which starts next April, will help alleviate some of these concerns.

Direct contracting is a set of three different voluntary payment models intended to appeal to a wide range of providers. Some of the models will focus on providers that service Medicare fee-for-service beneficiaries with complex needs or providers that have little experience in Medicare.

The agency aims to do more upfront testing under direct contracting to ensure the financial methodology is sustainable.

“Our hope is that if we can show those savings early on and we don’t have to have direct contracting version 1.0 or 3.0, we can have something that people can count on,” Smith said.

Speaker of the House of Representatives Nancy Pelosi and Treasury Secretary Steven Mnuchin reached an agreement on a Continuing Resolution (CR) to provide level funding for the federal government until December 11, 2020 (H.R. 8337). Previously, negotiations had stalled due to partisan disagreements regarding pandemic-related nutrition assistance and farm aid, both of which were included in the final bill. The House of Representatives passed the CR last night; the Senate is expected to quickly consider the bill.

The CR contains changes to the Medicare Accelerated and Advance Payment (MAAP) Programs (Sec. 2501). The bill extends both the period before repayment begins and the period before the balance must be repaid in full, reduces the recoupment percentage, and lowers the interest rate for payments made under the MAAP Programs and comparable programs between the date of enactment of the CARES Act and the end of the COVID-19 public health emergency.

The bill extends funding for Community Health Centers, National Health Service Corps, and the Teaching Health Centers Graduate Medical Education Program through December 11, 2020 (Sec. 2101), extends the work geographic practice cost index floor at 1.0 for localities currently less than 1.0 until December 11, 2020 (Sec. 2201), and delays Medicaid DSH cuts until December 11, 2020 (Sec. 2303).

The full text of the CR can be found here and a section-by-section summary here.

The American Public Health Association (APHA) released a discussion guide to be used while viewing the webinar recordings for the “Racial Equity Webinar Series.” The discussion guide includes a summary of each webinar, pre-webinar discussion questions, post-webinar discussion questions, an activity, and resources for each webinar. The webinar series is still ongoing.

Click here to download the discussion guide.
Click here to view the webinar recordings.