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CMS Innovation Center sharpens focus on health equity in new strategy refresh

In late October, the Facilities for Medicare & Medicaid Companies (CMS) launched its technique and imaginative and prescient for the CMS Innovation Heart in a white paper, Innovation Heart Technique Refresh, which can inform how value-based care fee fashions are designed and evaluated over the subsequent decade. Two main objectives for this subsequent interval of growth and transformation for fee and repair supply fashions in Medicare and Medicaid are reducing the burden of spending on people, households, states, and the federal authorities; and enhancing well being fairness by decreasing the impression of well being disparities.

To that finish, CMS highlighted 5 strategic targets:

  • Drive accountable care
  • Advance well being fairness
  • Assist innovation
  • Handle affordability
  • Accomplice to realize system transformation

These pillars are supposed to supply the framework for a well being system that achieves equitable outcomes by means of high-quality, reasonably priced, and person-centered care.

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For the reason that Innovation Heart was established as a part of the Reasonably priced Care Act in 2010, greater than 50 fee fashions have been created, of which solely six have been assessed as efficiently producing financial savings for Medicare. Nonetheless, these years of expertise have additionally introduced forth a number of key classes that inform the present technique refresh:

  • Guarantee well being fairness is embedded in each mannequin
  • Streamline the mannequin portfolio to scale back complexity and overlap
  • Use instruments to assist transformation in care supply and help suppliers in assuming monetary danger
  • Design fashions that persistently guarantee broad supplier participation
  • Cut back intricacy of monetary benchmarks to drive mannequin effectiveness
  • Encourage lasting care supply transformation

With the outlined focus and key classes, the Innovation Heart technique refresh signifies that CMS will assist all beneficiaries’ means to entry suppliers engaged in care transformation by addressing points akin to implicit bias in mannequin design, implementation, and analysis. This can be carried out by decreasing choice bias, enhancing mannequin designs, and fascinating various suppliers for participation, particularly suppliers in underserved communities and security internet suppliers. Accordingly, CMS will launch extra Medicaid-focused fashions going ahead.

The drive towards transformation within the coming years will embrace fewer fashions with much less overlap and extra readability concerning attributes. To assist transparency, CMS will make well timed, actionable knowledge out there to assist supplier decision-making, in addition to give choices for fee and regulatory flexibility to mannequin contributors. That flexibility can even embrace a evaluate of present fashions with potential revisions to incorporate modifications that tackle social determinants of well being. CMS notes that it’s going to intently collaborate with beneficiaries, suppliers, and payers throughout this strategic refresh to realize success in impression objectives.

Cotiviti’s Community Intelligence answer is uniquely positioned to assist the supply of high-quality care that promotes well being and reduces prices for members, networks, and the healthcare system. Watch our on-demand demo as we reveal Community Intelligence and talk about how one can put knowledge into motion to incentivize change by:

  • Figuring out and decreasing low-value care from inefficient and pointless providers
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