CMS: Many value-based payment models under review after several already delayed, withdrawn


Many of the Center for Medicare and Medicaid Innovation’s value-based care payment models are undergoing a review, according to the Centers for Medicare & Medicaid Services (CMS).

The statement to Fierce Healthcare comes after CMS quietly updated and delayed several payment models, including pulling a controversial model that ties payments to geographic health outcomes.

“CMS remains steadfast in its commitment to transforming the healthcare system into one that rewards value and care coordination,” the agency said. “The CMS Innovation Center and its alternative payment models help execute that commitment.”

The agency added it hopes to design models that support the adoption of value-based care.

“Many of the CMS Innovation Center’s models are currently under review, and we look forward to providing updates when available,” CMS said.

CMS did not return a request for comment on how many models are under review or which ones are being scrutinized.

The statement comes after CMS has quietly updated the webpages for two payment models to note major changes. The agency made an update to the webpage for the Geographic Direct Contracting Model that said it was currently under review.

A request for applications for the model was posted Jan. 1, and the first performance period was expected to start in 2022 and run through 2024.

The model was intended to improve quality and lower costs for Medicare beneficiaries across a region, and providers in that region can enter into value-based payment arrangements.

Providers can build integrated relationships and invest in population health to better coordinate care, the agency said when the model was released last December.

But the model has gotten pushback from some provider groups. The National Association of Accountable Care Organizations has criticized the model, saying it could confuse patients who may not know whether they are participating in a direct contracting entity.

CMS also quietly pushed back the first performance period for the Kidney Care Choices model, which aims to improve the quality of dialysis care.

The model had an implementation period for 2020 that enabled participants to create the necessary infrastructure for the model, which aims to bundle care from treatment of chronic kidney disease all the way through kidney transplantation and post-transplant care.

Starting Jan. 1, 2021, providers were supposed to start taking on financial accountability including capitated payments.

But CMS posted an update on the webpage for the model, saying the start of the financial performance period will now be Jan. 1, 2022. The agency did not give a reason for the delay.

CMS’ review comes on the heels of a separate analysis conducted under the Trump administration on the value generated by the payment models. The analysis found bundled payment models that gave providers an amount of money for an entire episode of care had mixed results, while global budget models, which give providers a fixed amount for the total number of services given over a certain period of time, were given a more positive review.

It remains unclear whether that analysis is playing any role into the review undertaken by the Biden administration.

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