Strategies for success in CMMI's most innovative models

The Center for Medicare & Medicaid Services Innovation (CMMI) has kept up a steady stream of new model announcements over the last several months, leading providers deeper down the road of value-based payments and bearing risk.

The new models include the Direct Contracting and Kidney Care Choices models. These models are designed to provide greater flexibility and incentives to align providers and transform care than previous models. The Direct Contracting and Kidney Care Choices models include capitated payment and two-sided risk arrangements.

Key to participants’ success is a strong learning system that enables participants to make informed decisions that accelerate and optimize performance in the models, and Premier is working to do just that. 

We are honored that the Centers for Medicare & Medicaid Services (CMS) and research firm Mathematica have selected Premier to support content development for the CMS Value Based Care Learning system. This new learning system will facilitate peer-to-peer learning among Direct Contracting Entities (DCEs), Kidney Contracting Entities (KCEs) and Kidney Care First practices.

The learning system activities embody the work Premier has been leading for more than a decade with hundreds of healthcare providers in our collaboratives – connecting providers, data and knowledge to accelerate progress and outcomes.

It’s a proven methodology: Hundreds of providers participating in Premier’s other collaboratives regularly outperform national standards and deliver cost savings and innovation, including in our Population Health Management Collaborative, Bundled Payment Collaborative, QUEST and in our new contract with the U.S. Department of Health and Human Services’ Office on Women’s Health to leverage our data and collaborative methodology to scale maternal health improvements nationwide.

Providers in alternative payment models need to build off core capabilities already in place, while also considering development of new clinical, technical and administrative functions.

Here are four essential capabilities they should aim for:

1. Streamlined and effective clinical operational models. These are essential to perform at advanced levels of risk. Providers must:

• Coordinate seamlessly across the continuum.
• Implement standardized workflows that support patient-centered care and reduce clinical variation.
• Develop a digital strategy to support virtual care.
• Work within a coordinated care management structure that integrates all at-risk populations.

2. A sophisticated high-value provider network and incentives strategy. The aim here is to drive care transformation and deliver cost savings at greater levels of risk.

The financial arrangements offered in Direct Contracting and Kidney Care Choice models provide an opportunity to develop downstream risk sharing and sub-capitation incentive models, which can include creative quality and efficiency bonuses and provide regular cash flow to physicians much sooner than in shared savings distributions. 

Given the heightened opportunities and risk, high-value networks should include:

• Primary care, specialist, post-acute care, ancillary and ambulatory providers
• Community partners
• Social services
• Behavioral health providers

Capitation also provides the freedom for providers to undertake activities that better coordinate beneficiaries’ care for which the fee-for-service system does not currently reimburse them. 

3. Advanced financial modeling and data analytics. In all two-sided risk models and particularly in models with capitation, entities will need to:

• Evaluate and benchmark the effectiveness and value of investment of clinical interventions.
• Establish interoperability between providers to exchange clinical data, coordinate care and manage leakage.
• Integrate electronic health record (EHR) clinical data with claims information to target performance improvement, conduct population segmentation and measure and predict performance over time.

4. Strategies, resources and education for beneficiaries and training for care teams. These activities and tools are essential to effectuate next-level patient activation, particularly in Kidney Care Choices. KCEs must have a strategy to engage patients early in their renal care trajectory regarding treatment choices and modalities, including transplantation and home dialysis.

KCEs will also be measured on patient activation measures, and both KCEs and DCEs will need a strategy to address patient experience of care, given the elevated importance of those measures. 

Participants that join advanced alternative payment models have the opportunity to lead the nation in value and population health strategy. These models challenge participants to disrupt care delivery, evolve risk-sharing arrangements and set an example for how to improve quality, experience and costs for beneficiaries.

The work excels and innovation is born when participants have a proven, data-driven partner – and a network of peers – standing behind them.

Learn more about Premier consulting and how we enable providers to safely reduce costs, generate shared savings and improve outcomes.