The Centers for Medicare & Medicaid Services (CMS) has announced a “new direction” for the CMS Innovation Center that is intended to “promote patient-centered care and test market-driven reforms.” The goal of these reforms – which may be tested on a smaller scale than current innovation models – is to “empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.”
CMS is particularly interested in testing models in involving the following focus areas (although the Innovation Center may also test models in other areas):
- Increased participation in Advanced Alternative Payment Models under the Quality Payment Program.
- Consumer-directed care and market-based innovation models. This could include allowing Medicare beneficiaries to contract directly with healthcare providers, having providers propose prices for treatments to inform beneficiary choices, offering bundled payments for full episodes of care and allowing providers to bid on the payment amount, and establishing preferred provider networks.
- Physician specialty models (e.g., specialty physician management of a defined population of beneficiaries with complex or chronic medical conditions, or paying providers for limited episodes of care based on quality measure performance and competitive pricing).
- Prescription drug payment models under Medicare and state Medicaid programs. CMS is particularly interested in models involving “arrangements between plans, manufacturers, and stakeholders across the supply chain,” such as value based purchasing arrangements and models that would increase drug pricing competition while protecting beneficiaries’ access to drugs.
- Medicare Advantage (MA) innovation models that provide MA plans with flexibility to innovate and achieve better outcomes.
- State-based and local innovation, including Medicaid-focused models.
- Mental and behavioral health models that enhance care integration and/or utilize episode payment, particularly in focus areas such as opioids, substance use disorder, dementia, and improving mental healthcare provider participation in Medicare, Medicaid, and CHIP.
- Program integrity approaches to “help CMS find the ideal balance between burdens on patients and additional workload created for the physician and effectiveness of the review.”
CMS will accept comments through November 20, 2017.