CMMI’s “New Direction” Points to the Future of Bundled Payments

A “new direction” is how the current Administrator of the Centers for Medicare and Medicaid Services (CMS) described the agency’s Innovation Center: Center for Medicare & Medicaid Innovation (CMMI). Seema Verma, the current Administrator of CMS, wrote a Wall Street Journal op-ed declaring the new changes for CMMI. With the proclamation come myriad questions. Perhaps most notably, what is the future of value-based care and what tools and payment models will organizations be able to leverage?

CMS’s recent Request for Information (RFI) supports Verma’s announcement and confirms that more inclusive, innovative care models, including bundled payments, are the future of healthcare.

After reviewing the RFI and other communications from CMS regarding the “new direction,” the team at Archway Health is encouraged by the tone and believe it reiterates a commitment to bringing more providers into the fold of innovative care.   

Embracing Bundled Payments

The priorities outlined in the RFI provide insight into what will be emphasized in this ‘new era’ of CMMI. The first three items on their priority list are Advanced Alternative Payment Models (APMs), Market-Based Innovations, and Physician-Driven Specialty Models. Bundled payments, and value-based specialty networks directly support all of these priorities by providing proven opportunities for cost reduction and quality improvement. As a result, we are confident that bundled payments will continue to play an integral role in the structure and payment of healthcare.  

The language included throughout the RFI also indicate that bundled payments are not slowing down anytime soon. Just last month, CMS proposed cancellations of two mandatory bundles, but bundled payments and episodes, particularly voluntary programs like the Oncology Care Model (OCM), are reinforced several times throughout the RFI.

Takeaway: Bundled payments remain a key to addressing healthcare payment reform and innovative models for care.

Physician- and Specialty-Driven Models

Notably, accountable care organizations (ACOs), hospitals, and PCPs were not mentioned at all in the RFI—a major shift in focus from an agency that once championed these care settings. This lack of inclusion gives us reason to believe that bundled payments will not only continue, but will be underscored as viable paths for physicians’ success under the APM track. In addition to a shift in focus of providers, discussion in the RFI of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) initiative, centered on developing physician-driven APMs, indicate that CMMI will much more focused on specialty care and specialty physicians.

Takeaway: The future of value-based care will be more inclusive of specialty and independent physician practices.

New Models Still Imminent

CMMI’s priorities and language throughout the RFI for its “new direction” signal that forthcoming programs, including the next generation of BPCI, will not be slowed down by the agency’s shift.

CMS has indicated that it is continuing to move full speed ahead with new models currently under development. We believe the agency-wide change in direction not only aligns with the aims of current programs in development, it further reinforces them.

Takeaway: Physicians should seriously consider and prepare for participation in new bundled payment models.

In a free, half-hour consultation, we can help healthcare providers, and specialists in particular, learn more about the imminent BPCI program update, and find potential savings in a provider-specific Bundled Payment Scorecard. To learn more, we welcome you to contact our team at info@archwayha.com.