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Value-based Payment Summit: CMMI Listening Session 1 - Speaker view
I said it fast to keep us moving and will use the chat function to expand a little on this benchmarking “do no harm” idea. Essentially the idea is that no participant should be charge more in a performance
Year than the bundle historically cost them in their benchmark years
Jake Rodriguez
How does mental health fit into specialty bundles?
Peter Grant
Advocate for a community based palliative care payment model. The specialty of palliative care is very skilled providing patient translation and care navigation in the setting of listening to what patients goals are instead of performing services that are not inline with the patients and their families goals.
Harold Miller
The American Academy of Hospice and Palliative Medicine developed a palliative care APM that was recommended for implementation by the Physician-Focused Payment Model Technical Advisory Committee, but CMMI refused to implement it.
Harold Miller
Specialists and primary care physicians have developed effective alternative payment models that can work both inside and outside of ACOs. 16 of them have been recommended for implementation by the Physician-Focused Payment Model Technical Advisory Committee, but CMMI has refused to implement any of them.
Davis Baird
Agree with rec on a comm-based pall care model - can be threaded through different provider settings in a co-management structure and gets to what many patients want most (navigation, coordination, being listened-to, pain and symptom management). CMMI's Medicare Care Choices Model (MCCM) tested something like this and it resulted in high-quality and real savings
Peter Grant
I am not hearing anything about advancing interprofessional-team based care and advancing those models....or person-centered care (which means care across the continuum. It still feels very fragmented, very siloed, very transaction-based. Excuse me if I am missing something but we are focused on episodes, specialty care...not comprehensive care.
Marian Grant
Palliative care also helpful earlier in an illness to help someone better tolerate curative treatment
Critical point about having the right granularity around Patient segmentation / patient phenotypes
Peter Grant
Thank you Melissa, we are working around the edges...and not focusing on fundamental redesign.
Allison Brennan, NAACOS
We can certainly do more and continue to evolve models, but it's also important to recognize that some models have been more successful than others. ACOs have demonstrated savings, both when evaluated against their benchmarks and with more sophisticated difference-in-difference analyses.
James Garnham
How do we bring the benefits of value-based care to the most complex folks like those with intellectual or developmental disabilities, mental health issues or substance use disorder? Can they be incorporated effectively into existing models through adjustments to quality metrics and actuarial models, or do we need to build new ones specific for them?
Allison Brennan, NAACOS
Great point Keely on exploring capitation. Center for Medicare should test optional capitation in MSSP. This is permitted by the MSSP statutory language from 2010 but is a tool that hasn't been used by CMS yet.
Travis Broome, Aledade
That is where we are. We are still finding so many ways to just not do unnecessary things either because they were never necessary or because people are healthier due to our efforts that more effectively doing necessary things loses the prioritization battles except for the really sick people that Tim was talking about.
Richard Ward
Everyone seems to like ideas that are not always feasible due to inadequate size: holding tiny groups of specialists "nested" within a local ACO context accountable for cost of care and patient-reported outcomes. The inconvenient truth for both cost and PRO is that at such scales, the noise is far larger than the signal. Therefore, need to consider specialty networks with larger geography than primary care ACOs to achieve critical mass.
Sandra Winfree
How can we help with care management and data from PCP/specialists/payor when 42CFR hinders that?
Allison Brennan, NAACOS
Great comments! I would also suggest for CMS to be mindful that clinical and payment transformation work is very difficult and takes time. The models need to have proper incentives to get providers engaged and keep them engaged and committed to participating.