The current administration has joined the Attorney Generals of various states to challenge the constitutionality of the ACA. The ACA created the Center for Medicare and Medicaid Innovation (CMMI).
Adam Boehler, the Director of CMMI, recently told provider and health plan executives that the administration would continue its shift to value-based payment in Medicare and Medicaid even if the ACA is struck down. A major concern is that if the ACA is found to be unconstitutional the $10 Billion CMMI budget would be eliminated.
CMMI’s new goals include moving the government from fee for service [FFS], away from FFS risk, and switching to a payment system that pays for outcomes instead of activity.
Key elements in new value-based models are:
- Simplicity
- Predictability
- Transparency of data
- Participation by multiple payers
Some of the new models will be based on recommendations of the Physician-Focused Payment Model Technical Advisory Committee (P-TAC).
The order of implementation of new models focused on disease groups will be determined by:
- Impact on costs
- Impact on quality
- Degree of difficulty in execution
It appears that one area of consistency from the current administration is the desire to continue switching to value-based care and moving away from FFS.