Shift to Value-Based Care Model Is CMS’ Top Priority

Data and more frequent dialogue is needed to improve the Medicare program, according to Dr. Meena Seshamani, Deputy Administrator and Director of the Center for Medicare, speaking during the 2024 NIC Spring Conference in Dallas.

“We all have to partner together to provide better care, improve population health and spend the healthcare dollar in a more effective way,” he said. “I want to drive everyone to a call to action.”

As has been part of industry conversations the past few years, a shift to value-based care arrangements is Seshamani’s top priority, she said.

All Medicare beneficiaries are expected to be treated by a provider in a value-based care model by 2030, according to the Centers for Medicare and Medicaid Services (CMS).

This value-based care is an “effort to rethink how healthcare is provided,” she said.

For example, instead of treating illnesses on a fee-for-service basis, value-based care models treat the whole person with the aim of keeping them healthy to ultimately drive better outcomes at a lower cost.

Seshamani said there is an opportunity to provide people with care where they live but that senior living is not considered a provider under the Medicare law.

That is where partnerships that are data-driven to demonstrate quality and cost, can enable what CMS is seeking, Seshamani said, and “that is where the power of value-based care comes into play.”

Senior living providers were encouraged to consider possible partners in Accountable Care Organizations (ACOs) and Medicare Advantage plans – both value-based care models.

ACOs, for example, take responsibility for the cost and quality of care provided to patients. If an ACO meets quality metrics and saves Medicare money, then the ACO shares in the savings, according to NIC.

“ACOs have knocked it out of the park on quality measures,” Seshamani said. “It’s an example of how partnerships can work to everyone’s benefit.”

She said data and transparency is needed to encourage innovation and market competition in ways that are central to CMS’ mission.

As for what to track, CMS says senior living providers should focus on tests such as screening for depression, blood pressure, and diabetes, among others. CMS also has an innovation center to test new program models and metrics.

Session facilitator David C. Grabowski, PhD, Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School, observed that prior authorizations and denials of care required by Medicare Advantage plans are common pain points for skilled nursing providers.

Providers are encouraged to look for partnerships to solve for staffing shortages, Seshamani said. For example, Medicare pays for certain community health services.

CMS recently issued a request for comment on Medicare Advantage plans to gauge the effectiveness of the model. Ideas should be submitted by the end of May.