Yet worries about FFS vs. VBC continue. What if CMS scuttles MACRA? What if Trump ends the CMS Innovation Center (CMMI), born of the Affordable Care Act and from which alternative payment models are designed?
There are a lot of barriers in the way, and the RFI CMS published a few months ago seeking comment on ways to recast CMMI did not signal doom in its language. (Meantime there is talk in Washington, D.C. that a new CMMI director is to be named soon, and that a new voluntary bundled payment model may be announced by CMS in time for MACRA 2018.) Speaking of barriers, MACRA itself is a law, and CMS has finalized the program for 2018. It includes the new ACO Track 1+ designed to bring more providers into ACOs, and it foreshadows multi-payer models beginning in 2019.
And looking closer at the CMMI RFI put out by CMS, the language is about expanding types of models, and as PTAC desires, finding ways to test models via limited demonstrations and episodes of care before they reach any requirement stage. The RFI sought comment on how to construct models in which providers could actually bid into episodes of care and in which beneficiaries could reap shared savings, along with solicitation on other types of specialty models. All told it’s hardly a blueprint to end value-based care.
The RFI also sought comment on Medicare Advantage, behavioral health integration and Medicaid models among others. Philips Wellcentive submitted comment to the RFI, and we will share its details once public.