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In an effort to promote more preventive health practices, the Center for Medicare and Medicaid Innovation is testing 28 models that would base provider payment for clinical services on quality and value. The number is expected to grow in the coming years, said CMMI Chief Medical Officer Dr. Dora Hughes.
The alternative payment models, meant to ease the industry away from the typical fee-for-service model, vary by targeted medical condition, practice location and type of services rendered. Perhaps the best-known is ACO REACH, or the Accountable Care Organization Realizing Equity, Access, and Community Health Model. The value-based framework, which replaced the Global and Professional Direct Contracting Model earlier this year, requires participants to identify and outline plans to mitigate disparities among Medicare beneficiaries.
In August, CMMI announced 110 ACOs had been provisionally accepted to participate in the model beginning Jan. 1, 2023.
Another model, as outlined at the symposium, addresses social issues alongside clinical care in six states for children on Medicaid or the Children’s Health Insurance Program. Its goals are to improve child health and reduce avoidable inpatient stays and out-of-home placements, such as foster care.
A third model aimed at maternal opioid misuse focuses on postpartum mothers on Medicaid. Eight organizations use enhanced care coordination and connection with social services to improve outcomes for mothers and their babies.
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