The Obama administration is touting continued progress in achieving its goal of tying half of all healthcare spending to alternative payment models by the end of 2018.
HHS Secretary Sylvia Mathews Burwell also said the CMS would give providers more opportunities to become involved in Medicare's alternative models.
“That's incredible progress. It's historic,” she said. “But it's just a start. We have a long road ahead.”
Burwell said the CMS will re-open the Next Generation ACO and Comprehensive Primary Care Plus (CPC+) models to applicants for the 2018 performance year. Both models qualify as an advanced APM in the new framework for paying physicians established by the Medicare Access and CHIP Reauthorization Act.
Burwell, speaking at a summit hosted by the Health Care Learning Action Network, a public-private partnership that works to advance APMs and is known as LAN, said the report shows 23% of all healthcare dollars--from Medicare Advantage, Medicaid and private health plans--went through APMs in 2015.
Contracts in place at the beginning of 2016 put 25% of healthcare payments through APMs, and the actual amount will be higher because of contracts negotiated throughout the year.
The report surveyed 72 health plans covering more than 128 million Americans, or about 44% of the covered population in Medicare Advantage, Medicaid and commercial plans.
Dr. Sam Nussbaum, chair of the LAN group that led the effort and chief medical officer for insurer Anthem, said the findings are limited because plan participation was voluntary. Also, some plans were not able to report subcategory payment methods and there was potential variation in the interpretation of metrics. He said the report still “truly represents where America is,” in regards to the goal.
LAN places payment models into four categories: fee-for-service; fee-for-service with adjustments for quality metrics; APMs built on a fee-for-service architecture and APMs that pay for population health management efforts. Models that fit into the third or fourth category qualified as an APM for the purposes of the report.
Nussbaum said those models will not work in all areas or with all patient populations but further efforts to develop a common language around APMs and determine what models are most effective is important.
“We believe this is a vital goal to work to achieve,” he said.
Patrick Conway, CMS chief medical officer and director of the innovation center, said the agency now wants to work with the private sector.
HHS said in March it had already met its goal of tying 30% of fee-for-service Medicare payments to quality or value by the end of 2016. Much of that, however, reflects models that don't carry enough financial risk to qualify as advanced APMs, which would allow participants to bypass the new incentive-payment framework rolling out soon under MACRA.
Currently 18 ACOs participate in the Next Generation model, which started in January. Three ACOs had dropped out by July. The CPC+ model will launch next January with 57 participants in 14 regions. It has two tracks, one of which relies more heavily on the traditional fee-for-service model.
Provider groups and lawmakers have expressed concern, meanwhile, that the CMS is pushing too many experiments too quickly for proper evaluation, but administration officials continue to laud the efforts of the CMS Innovation Center, which is continuing to create and test new models.
Some studies have suggested that value-based payment systems and pay-for-performance schemes often fail to achieve significant improvements in quality and efficiency because of overly complex designs and conflicting incentives.
