CMMI’s “New Direction” Points to the Future of Bundled Payments

In a September commentary in the Wall Street Journal, Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMS), called for a “new direction” for the Center for Medicare & Medicaid Innovation (CMMI). The proclamation sparked many questions, perhaps most notably the following one: What is the future of value-based care, and what tools and payment models will organizations be able to leverage?

CMS’s recent request for information (RFI) supports Verma’s announcement and confirms that more inclusive, innovative care models, including bundled payments, are the future of health care.

Although the comment period for the RFI has ended, providers should be encouraged by the tone of the RFI and other communications from CMS regarding the “new direction” as the agency reiterates a commitment to bring more providers into the fold of innovative care.  

Embracing Bundled Payments

The priorities outlined in the RFI provide insight into CMMI’s focus going forward. The first three items on the organization’s priority list are advanced alternative payment models (APMs), market-based innovations, and physician-driven specialty models. Bundled payments and value-based specialty networks directly support all these priorities by providing proven opportunities for cost reduction and quality improvement. As a result, bundled payments likely will continue to play an integral role in the structure and payment of health care. 

The language included throughout the RFI also indicates that the move toward bundled payments will not be slowing anytime soon. Although CMS recently finalized cancellations of two mandatory bundles, bundled payments and episodes—particularly voluntary programs like the oncology care model—are reinforced several times throughout the RFI.

Physician- and Specialty-Driven Models

Notably, accountable care organizations (ACOs), hospitals, and primary care physicians are not mentioned at all in the RFI—a major shift in focus from an agency that once championed these care settings. This lack of inclusion may indicate that bundled payments not only will continue, but also will be underscored as viable paths for physicians’ success under the APM track. In addition to a shift in focus of providers, discussion in the RFI of the Physician-Focused Payment Model Technical Advisory Committee initiative, centered on developing physician-driven APMs, indicate that CMMI will be much more focused on specialty care and specialty physicians.

New Models Remain Imminent

CMMI’s priorities and language throughout the RFI signal that forthcoming programs, including the next generation of the Bundled Payments for Care Improvement (BPCI) initiative, will not be slowed by the agency’s shift. CMS indicated in a statement at the end of November that it is continuing to move full speed ahead with new models currently under development. The agencywide change in direction not only seems to align with the aims of current programs in development, but also reinforces them.

With CMS steering the healthcare industry in a new, physician-led direction, providers can stay ahead of payment reform with bundled payment programs. The changes happening at CMS should be heartening to physicians as they will be championed as leaders in the continued shift from fee-to-service to value-based care. 

Dave Terry is CEO & Co-founder at Archway Health, Watertown, MA.