9 Key Trends: How CMS is Aligning Value-Based Arrangements Across Traditional Medicare Programs

The goal: All Medicare coverage to be under a value-based payment arrangement by 2030.

The Centers for Medicare and Medicaid Services (CMS) is committed to expanding value-based care. The goal: to bring 100% of original Medicare beneficiaries into an accountable care relationship by 2030.

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

WHAT IS AN ACCOUNTABLE CARE RELATIONSHIP?

• Accountable Care: A doctor, group of health care providers, hospital or health plan takes responsibility for improving quality of care, care coordination and health outcomes for a defined group of patients, thereby reducing care fragmentation and unnecessary costs for patients and the health system.
• Accountable Care Organizations (ACOs): Groups of doctors, hospitals, and other health care professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. ACOs may be in a specific geographic area and/or focused on patients who have a specific condition, like chronic kidney disease.
• Value-Based Care: Care that focused on performance, quality, and the patient’s experience of care.

A good example of an accountable care relationship is the relationship between a Shared Savings Program Accountable Care Organization (ACOs) and their assigned beneficiaries.