CMMI Prioritizes Multi-Payer Alignment in New Models

October 31, 2023 · Marilena DeGennaro

It’s a marathon, not a sprint,” said Liz Fowler, Director at the Center of Medicare and Medicaid Innovation (CMMI), during a recent Fireside Chat with NCQA Executive Vice President Eric Schneider. They were discussing CMS’s mission to have all Medicare members, and the majority of Medicaid beneficiaries, enrolled in accountable care programs by 2030.   

Dr. Fowler highlighted the new AHEAD model, CMMI’s multistate cost-of-care model that curbs health care costs, improves population health and health outcomes and addresses health disparities.

The model is designed to be flexible enough to help support states’ ongoing transformation efforts and address their most important priorities—but it will require significant restructuring of health spending across all payers.  

The Innovation Center also released the Making Care Primary (MCP) model and the GUIDE model this year, innovative solutions to achieve multi-payer alignment and focus on populations that have historically been underfunded in health care. The MCP model builds on previous CMMI models (Comprehensive Primary Care, Comprehensive Primary Care Plus, Primary Care First) to enable more providers and practices to move into primary care, with an explicit focus on safety-net, rural primary care centers and Federally Qualified Health Centers.  

“It’s really an on-ramp to value-based care through upfront infrastructure payments and our approach to state partnership… instead of a broader geographic scope, with this model we focused on fewer states with greater depth,” said Dr. Fowler. 

The GUIDE model is the first of its kind to address health care costs and target reductions in federal spending on long-term nursing home placement. It offers critical support to individuals living with dementia and their caregivers, to establish ongoing, longitudinal assistance through an interdisciplinary care team.  

Using Lessons Learned for Developing New Models 

The AHEAD, MCP and GUIDE models learned from CMMI’s successes and failures. The team listened closely to past stakeholder and participant needs and recognized that current models need to last longer than 5 years. The AHEAD model is slated to last until 2034, which allows the investment to be truly transformative and impactful. 

As Dr. Fowler put it, “We’re really thinking about health system transformation and really putting more of an emphasis on quality improvement. And then we’re also developing an approach for certification based on quality improvement and patient experience.”

Reflecting on his experiences as a primary care provider, Dr. Schneider shared that providing coverage to vulnerable populations can be a delicate balance of costs—but that as states allow these explorative payment models into their programs, there can be a reduction in cost without sacrificing quality. 

Dr. Fowler is hopeful that these long-term investments can align payers and promote value-based care. Reflecting on the models’ construction around the idea of maintaining quality and being person-centered, she added that they “provide a more flexible payment arrangement… to get providers out of the hamster wheel of 15-minute visits and a lot of paperwork.”

The Path Forward 

In addition to releasing these new models, CMMI is continuing its work in under-represented areas, exploring innovations for behavioral and maternal health, working to integrate specialty care into primary care and building on current and past models to improve health care costs for all payers. 

NCQA is eager to continue the conversation on multi-payer alignment and tracking state innovations.

To learn more about the CMMI models, you can watch and listen to the full conversation here. 

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