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Value-based Payment Summit: CMMI Listening Session II - Speaker view
Melissa Urrea
Suzanne, thank you for sharing. I find this very interesting. What does ESCO stand for?
Nick Bluhm
End-Stage Renal Disease Seamless Care Organization.
Dan Weiner, Tufts MC
In many ways, CKD stage 3 and CKD stage 4 are very, very different entities, with a different focus. But Kevin is right that it begins with awareness.
Jonathan O'Donnell
That "awareness" is only actionable and relevant when accountability is broad.
Jonathan O'Donnell
ESCO and CJR, BPCI, etc start with "incision" or "dialysis start"...which is too late
Dan Weiner, Tufts MC
The new KCC models begin at CKD stage 4 for the purpose of spanning 'silos'.
Jonathan O'Donnell
Marian Grant
Palliative care could be so helpful for those with stage 3 and 4 kidney failure to help them have a better understanding of their illness, make more informed decisions about treatment like dialysis, and support for them and their loved ones for however long they may still have to live.
Harold Miller
What PCPs need from Medicare and other payers is adequate and appropriate payment, not shifting of the payer’s risk. An effective way to pay for primary care is described in detail at https://patientcenteredpayment.chqpr.org/PrimaryCare.html
Harold Miller
In order for specialists to work successfully with primary care, specialists need to be paid adequately and appropriately for the types of patients specialists need to treat. More details are at: https://patientcenteredpayment.chqpr.org/Overview.html#2.Patient-CenteredPaymentforSpecialtyCare
Richard Ward
Suggestions to CMMI from Reward Health summarized in blog post at: https://rewardhealth.com/archives/3517
Catherine French
How should surgeons be engaged?
Sandy Marks
Team of Teams would be a great approach
Richard Ward
Within local ACOs, each specialty includes few providers and lacks critical mass for innovation investment and lacks actuarial stability for both total cost of care and patient-reported outcomes. Therefore, need models to engage specialists organized into larger networks. Relationship between primary care and specialists must be a matrix, rather than a tree. More details at: https://rewardhealth.com/archives/3488
Travis Broome, Aledade
I think we are all in agreement that there many if not most situations where CPT code FFS payments are not the ideal for speciality care. The debate seems to be are who will design and run the alternative to FFS. What new financial incentive comes into play? Does it encourage patient-centered coordination? Does it only pay for value creation or does it move money from one party to another party?
Dan Weiner, Tufts MC
Peter - agree.
Dan Weiner, Tufts MC
My other major comment here is that I think we need to be careful with incentivizing 'bigger' as 'better'; this is particularly notable with rural and less densely populated areas.
Suzanne Watnick, Northwest Kidney Centers, UW
Any way we can cover a team-based approach brings greater expertise to patients - it incentivizes innovation.
Nick Bluhm
To supplement Travis's point, the difference of opinion as it relates specialty models will carry implications for which "entity" does the work in defining the incentives for specialty care. "Carve-outs" or specialty models rely on the centralization of administration at CMS; the alternative is to delegate that work to the ACOs, many of which may not have the volume or capacity to appropriately engage with all willing specialists.
Dan Weiner, Tufts MC
And agree with Shawn. In MA risk adjustment, all dialysis patients look the same (and that may be OK b/c they are a small portion of the larger population). In a kidney model, all of these patients are actually very different.
Ronald Barkley
Suzanne Watnick, Northwest Kidney Centers, UW
I would suggest that CMMI consider flexibilities around systems' participation in various models. If they are participating in a primary care - type of model, they may not consider the specialty models, and then we are way behind in gaining needed experience that we need to gather around some of the most complex patients....
Dan Weiner, Tufts MC
Agree, Suzanne
Peter Grant
Agree with Suzanne and Dan’s comments about CMMI flexibilities around systems’ level of participation. Yet, also consider promoting accountability—with transparency—on *extent* of participation as well as communication among a patient’s team of providers…
Melody Danko-Holsomback
Agree with Ashley to create incentives to engage beneficiaries to be more involved with higher quality providers would be very beneficial.