CMMI Lays Out New Vision for Value-Based Care Demonstrations

WASHINGTON, D.C. (November 2, 2021)—At a recent virtual event, Centers for Medicare & Medicaid Services (CMS) leaders, including Administrator Chiquita Brooks-LaSure and Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler, unveiled the agency’s refreshed strategic vision for developing, implementing, and evaluating new care delivery and payment model demonstrations. Top officials reviewed highlights from a white paper spelling out the details of CMMI’s new direction (Innovation Center Strategy Refresh).

CMMI will be guided by five new strategic objectives, including:

• Driving accountable care
• Advancing health equity
• Supporting care innovations
• Improving access by addressing affordability
• Partnering to achieve system transformation

The white paper fleshes each of these objectives out further, incorporating specific goals and metrics relevant to each. Importantly for home health providers and the entire home-based care field, the strategy makes numerous specific mentions of the importance of supporting more care in home- and community-based settings. For example, under the “Supporting Care Innovations” bucket, CMMI states that beneficiaries should have greater access to care in the home and community, and providers should be allowed greater payment and regulatory flexibility to support home-based care. CMMI also intends to solicit more feedback and input from beneficiary and caregiver groups, as well as providers, on preferences for home-and community-based treatment choices.

The Innovation center expects to advance its work on “total cost of care models that can support home- and community-based care that meets patient and caregiver needs and preferences.” In addition, when highlighting gaps in care that they intend to address, CMMI called out behavioral health, social determinants of health and palliative care. The National Association for Home Care & Hospice (NAHC) expressed gratitude at the specific mention of palliative care. Providers are experts in the provision of this holistic care for people with serious illness, and an important policy priority is the development of a community-based palliative care demonstration that hospices, home health agencies and other home-based care providers can participate in, the association said in a press release.

The new strategy’s emphasis on increased public transparency and data-sharing with stakeholders is also welcome news for the industry, NAHC said. More timely and easier access to CMMI model participation, process, and outcomes information is critical to ensure demonstrations are working as intended, and if not, that they can be modified in real-time to address shortcomings. CMMI’s plan to share claims and non-claims-based data from models with researchers and the public is welcome news.

As has been signaled since the beginning of the Biden Administration, CMMI is taking a “health equity first” approach to its model development and review work. Demonstrations will be designed from the start with the goal of reducing health disparities, and all new models will likely contain specific metrics capturing more detailed demographic data and measuring impact on beneficiaries from disadvantaged communities. NAHC applauded this effort, recognizing that much work needs to be done to increase access to high-quality innovative home-based care for people from underserved communities of color.

In the coming weeks, NAHC said it plans to meet with CMMI leaders to discuss this new direction and advocate for increased opportunities for home-based care providers of all types and sizes to participate in the value-based models of the future.