Workforce: How Will Medicare Fee-For-Service Trends Change the Way You Think About Future Staffing Needs?

8 Key Trends: How CMS is Aligning Value-Based Arrangements Across Traditional Medicare Programs In January 2022, Centers for Medicare and Medicaid Services (CMS) announced their commitment to 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. Actions to Move Medicare Beneficiaries into Accountable Care Relationships Aligning key aspects of value-based arrangements across CMS can help set the stage for broader synchronization of the health care delivery system and move health care providers to higher levels of delivery system transformation. Actions are aimed at improving program alignment. In an article published in Health Affairs, CMS leaders outline the efforts the agency is making in support of its goal to support the transition to value-based care and have all traditional Medicare patients in an accountable care relationship by 2030. 8 Key Trends: How CMS is Aligning Value-Based Arrangements 1. Traditional Medicare: CMS is aligning value-based arrangements across the Center for Medicare and the Innovation Center (CMMI). As one example, CMS describes how this alignment is important to prevent selective participation by health care providers and to ensure that lessons learned lead to improvements and advancements in quality, equity, and value in the Shared Savings Program and other ACO models. 2. Medicare Advantage (MA): CMS is exploring ways to align MA with value-based efforts in Traditional Medicare, including the Shared Savings Program and Innovation Center models. In Medicare Advantage (MA), which makes up 45% of Medicare enrollment, there is an increasing percentage of payments to health care providers made in advanced value-based arrangements. 3. Physicians: The Merit-based Incentive Payment System (MIPS) is a pay-for-performance program in Traditional Medicare. MIPS was designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care. Clinicians get positive, neutral, or negative adjustments to their fee-for-service payments based on their performance in four categories: quality, cost, promoting interoperability, and improvement activities (improving care processes, enhancing patient engagement, and increasing access). Through participation in MIPS, clinicians are prepared to progress to the Shared Savings Program or other value-based arrangements. 4. Hospice: The VBID model assesses a broad array of MA service delivery and/or payment approaches and contributes to the modernization of MA through increasing choice, lowering cost, and improving the quality of care for Medicare beneficiaries. CMS is gradually migrating some hospice payment structures towards value-based payments. Future Initiatives 5. Health Equity: CMS recently proposed to adopt a health equity adjustment to quality performance scores in the Shared Savings Program, which would reward ACOs that provide high-quality care to people who are dually eligible for Medicare and Medicaid or who live in underserved communities. For example, for hospitals subject to hospital readmission reduction program (HRRP), researchers have identified that patients’ poverty, disability, housing instability, and residence in a disadvantaged neighborhood were associated with higher readmission rates, and safety net institutions are disproportionately penalized as a result. Accounting for social risk factors can reduce negative unintended consequences of the HRRP. The design of value-based arrangements in Medicare can be a useful tool for advancing health equity by encouraging the movement of care upstream to address the health-related social needs and disparities that can lead to or exacerbate poor health outcomes. 6. ACO Reach Model: In the ACO Reach Model, CMS’s Innovation Center is evaluating a novel benchmark adjustment that rewards ACOs that serve a higher proportion of underserved beneficiaries. If this approach proves successful in addressing health disparities, it may inform future policy in the Shared Savings Program. 7. Special Needs Plans: CMS is identifying how our nation’s health care infrastructure can better address social needs for people with Medicare. CMS is newly requiring that special needs plans screen for housing, food, and transportation through an annual health risk assessment 8. Social Determinants: CMS has proposed the adoption of social-determinants-of-health quality measures in the Hospital Inpatient Quality Reporting (IQR) Program to assess whether health care providers are appropriately screening for health-related social needs; CMS has also solicited comment on a similar measure for Medicare Advantage (MA) Star Ratings. To achieve these objectives, CMS is looking forward to close partnerships with health care providers, payers, people with Medicare, and stakeholders across our health care system. CMS remains committed to advancing value-based care in a way that best meets the needs of people with Medicare, who deserve high-quality, equitable care. 4 Leadership Questions How do CMS’s initiatives affect your future labor force and/or staffing positions? Newton’s third law certainly applies here to all healthcare providers. For every action (force) in nature, there is an equal and opposite reaction. If object A exerts a force on object B, object B also exerts an equal and opposite force on object A. In other words, forces result from interactions. Is your organization prepared for traditional Medicare moving into value-based care? How will this change your referral relationships and opportunities? How will this affect your labor force? What are the opportunities to align financial, clinical, and quality incentives with your referral partners? CMS Innovation Center’s Strategic Objectives 5 Valuable Resources CMS Innovation Center 2021 Strategy Refresh – Putting All Patients at the Center of Care Medicare Shared Savings Proposal 7 Models That Will Accelerate Value Based Payments in 2021 5 Things to Know About Hospice Benefits 2022 CMS Innovation Center Strategy Refresh Report

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Workforce: How Will Medicare Fee-For-Service Trends Change the Way You Think About Future Staffing Needs?

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

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