Blog

In its recent Strategy Refresh, the Center for Medicare and Medicaid Services’ Innovation Center performs a needed introspection of the work done to-date with the alternative payment models piloted and fully implemented, and lays out a clear agenda for continuing its work and meeting important objectives. This report, which is the focus of the virtual Value-Based Payment Summit, has elicited many reactions from health policy experts and, in some cases, raised questions about the potential negative impact of these models on Medicare beneficiaries and the enrichment of model participants at the expense of the Medicare Trust Fund.

In a recent blog post examining what it will take to restore patient confidence in a fair and equitable delivery system, Dr. Daniel Wolfson, EVP and COO of the American Board of Internal Medicine Foundation, and I expose the significant challenges to establishing trust when money gets in the way. And money gets in the way when it drives both parties away from each other rather than towards each other. That happens all too often today, and here’s how.

A decade after its creation, it’s time to take stock of the Center for Medicare and Medicaid Innovation’s (CMMI) progress and challenges.

When the Medicare Bundled Payment for Care Improvement (BPCI) program was launched in 2013, it was the first national alternative payment model that put providers at financial risk (for any losses incurred on the patients they manage) from day one of the program. In 2018, BPCI was replaced by BPCI-Advanced. By then, it had grown substantially from its early roots to representing over $10 billion in at-risk contracts per year with providers in all but one state. And it’s still going strong today.

For decades now, employers have been at the forefront of health care transformation, continuously pushing for greater price and quality transparency, demanding better value from the delivery system, and encouraging plan members to be better consumers. Despite their efforts, progress has been slow. Employers continue to see health care prices increase, crowding out other investments and stifling pay raises. Quality improvements have been modest and, in some cases (like maternity), have worsened. Pricing transparency remains elusive.