The Center for Medicare proposed an overhaul of the Medicare Shared Savings Program, which is CMS’ permanent accountable care organization program, back in July. What’s behind those changes?
Back in January, I published—along with our administrator Chiquita Brooks-Lasure and Center for Medicare and Medicaid Innovation Director Liz Fowler—a vision for Medicare around several pillars: namely, advancing health equity, expanding access to coverage and care, driving innovation for high-quality, whole person care, and promoting good stewardship of the program with affordability and sustainability for future generations. The Medicare Shared Savings Program, and our value-based care programs overall, are really a key way to drive those pillars.
The shared savings program is able to encourage more coordinated care, bringing in health-related social needs issues, encouraging a more team-based approach to care, and being able to reward providers who are providing high-quality care and spending the Medicare dollar in the most effective way to drive better outcomes.
With that high-level strategic vision in mind, we have proposed several changes to the Medicare Shared Savings Program.
If these MSSP proposals are finalized, what will success look like?
At a very high level, we want to drive better care—to have improved outcomes and healthier populations with smarter spending.
We want to be able to grow participation in these models. We want to have a defined and deliberate focus on equity in these models, to really get at the myriad issues that go into someone’s health and the disparities that have existed in our society around health and healthcare. And being able to align our programs across Medicare: As a provider who was, until recently, leading a lot of these care transformation efforts, I know how important it is that we’re all rowing in the same direction, and engaging in a thoughtful way together to be able to make improvements.
Another program that’s been top of mind for Modern Healthcare readers lately is Medicare Advantage, which also falls under your purview. CMS recently accepted comments on a request for information about the program. Why did you decide to release the RFI?
We want to make sure that we continue to improve Medicare Advantage so that [it’s based] on the strategic pillars of equity, of access, of innovation, of stewardship. We are very heartened by all of the interest that we have gotten, all the comments we’ve gotten, from people with Medicare, to entrepreneurs and innovators, to plans, to providers. There are so many people involved in the Medicare Advantage program. That’s a key piece to how we’re going to be able to move forward together and continue to improve Medicare overall.
Medicare Advantage is expected to enroll more than half of all [Medicare] beneficiaries as soon as next year. What does your office need to do to adapt to this shift?
I think what we are doing is exactly what we need to do, in that Medicare Advantage is a key part of the Medicare program. You have Parts A and B in our traditional Medicare—we talked a little bit about the value-based care models, what we’re doing there as well. Then you have Part C, Medicare Advantage, you have Part D for prescription drugs, and then you have supplemental insurance such as Medigap. All of those pieces together create the Medicare program. It is so key that through our policymaking, through our operations, we are driving all of those toward the strategic pillars that I mentioned, and doing so in partnership with everybody involved in making care happen for people who rely on our program.