Providers participating in accountable care organizations and other value-based payment arrangements with Medicare have a wish list for the new team running the Centers for Medicare and Medicaid Services.
Less than four months into President Donald Trump's second term, and just over a week since Dr. Mehmet Oz became CMS administrator, the agency is poised to begin putting its stamp on the programs it manages, including its value-based care initiatives, in a series of proposed rules over the coming weeks.
Related: Why more providers are enlisting value-based care consultants
These regulations to update fee-for-service Medicare reimbursements for providers may offer insights into where CMS aims to take these efforts, and how that may diverge from the agency's priorities under President Joe Biden. For instance, CMS declared in 2021 that it wanted all fee-for-service Medicare beneficiaries covered under value-based care arrangements by 2030, a goal the new administration has neither endorsed nor rescinded.
The future of critical value-based care programs is at stake. Notably, CMS has a big decision to make about whether to extend the ACO Realizing Equity, Access and Community Health, or ACO REACH, model, which is scheduled to sunset after 2026.
“Leaders are just taking their seats, but at some point, I think we would hope to hear some statements around goals,” said Ashley Ridlon, vice president of health policy at the value-based care management company Evolent.
These are three top priorities for value-based care program participants in 2025:
Recommit to value-based care
The industry seeks a refreshed strategy from CMS, or at least a signal of what its priorities are. The administration hasn’t done much proactive Medicare policymaking to date, but the Center for Medicare and Medicaid Innovation terminated four payment models last month and announced it would unveil a new plan at a later date. The agency did not respond to questions about what it might do or when.
Value-based care plays a key role in reducing federal spending while improving care for Medicare enrollees, according to America’s Physician Groups, which aligns with the goals Trump, Oz and Health and Human Services Secretary Robert F. Kennedy Jr. have espoused.
“The solution doesn't always have to come from the government. But just knowing that this is a trajectory that's going to continue — it's what we want to see, where we want to go,” Ridlon said.
Sustainable financial model
ACOs and value-based care advocates think it’s critical to both long-standing and new participants to offer a stable financial model. Overall, maintaining steady value-based care programs such as the fee-for-service Medicare Shared Savings Program makes joining the arrangements more attractive, they said.
More specifically, CMS could continue recalibrating these programs to reduce regulatory obstacles. That could entail steps such as updating the benchmark formulas and addressing the so-called “ratchet effect,” which makes it difficult for ACOs that have saved money in the past to receive bonus payments for additional, incremental improvements.
That becomes harder to accomplish over time as participants maximize efficiency and savings, said Aisha Pittman, senior vice president of government affairs for the National Association of ACOs.
“If you're ensuring folks have adequate budgets, you can produce more savings. As you have more opportunity to share in those savings, you can reinvest and do different care interventions that lead to successful outcomes. That is attractive to providers,” Pittman said. “If you're going to try to bring more folks into the program, there have to be opportunities for them to be successful.”
Reducing burden
ACOs and value-based care providers are asking CMS to reduce the administrative burden to participate in its payment models.
For instance, participants are concerned about health information technology interoperability reporting requirements that kicked in Jan. 1. The agency aims for all Medicare Shared Savings Program ACOs to electronically report on quality measures this year.
These measures are derived from electronic health records, and most ACOs use at least one electronic health record system and must compile and standardize data from multiple platforms.
Sunflower ACO CEO Dan Roberts said the electronic clinical quality measurement reporting structure often misses things that aren’t contained in EHRs, such as blood sugar levels in diabetic patients. CMS could restore some manual data reporting options to resolve this problem, he said.
