Timeline Set for Shifting Medicare Payments to Value-Based Arrangements

CMS announced a timeline and measurable goals for moving Medicare reimbursement from volume-based to value-based payments. CMS’ plan seeks to “reward value and care coordination – rather than volume and care duplication.” By the end of 2016, CMS intends to tie 30 percent of Medicare Fee-for-Service (FFS) payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs), bundled payment arrangements and integrated Medicare-Medicaid demonstrations. By the end of 2018, under CMS' plan, the percentage of FFS payments made under such alternative models would rise to 50 percent. Overall, CMS seeks to tie 85 percent percent of FFS payments to quality or value, whether through an alternative payment arrangement or through quality-based FFS payments, by 2016. Today, according to CMS, such payments amount to 20 percent of Medicare payments.

In addition, CMS intends to expand these goals beyond Medicare, to Medicaid and commercial payers, through the creation of a Health Care Payment Learning and Action Network. Through the Network, HHS will work with private payers, consumers, providers, states and State Medicaid programs and other partners to expand alternative payment models.

On a parallel track, New York State has committed to adopt value-based payment arrangements under the Delivery System Reform Incentive Payment (DSRIP) and Fully Integrated Duals Advantage (FIDA) programs. It has convened a Value-Based Payment Workgroup and has solicited comments on a draft “Roadmap”, which will be submitted to CMS for approval. Comments on the Roadmap may be submitted to dsrip@health.ny.gov by 3 p.m., Mon., March 30. LeadingAge New York is participating in the workgroup.

For more information about the CMS plan, see the CMS Fact Sheet, available here. More information about the New York State Work Group and Roadmap is available here.

Contact: Dan Heim, dheim@leadingageny.org or Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.