Nancy Taylor – VP PUblic Policy and External Relations at the Permanente Federation
Jonathan Blum – Deputy Administrator and Director of CMS
72% of people in Medicare use fee for service. This is shrinking as people choose alternative private plans. Encouraging plans to think about wellness and managing care. Shared Savings program – driven by need to create multiple pathways for people at different stages of development as an Accountable Care Organization (ACO) to participate. The Pioneer track is created using CMS’ innovation authority. 32 Pioneers have signed contracts. They will test different options including payment methodologies, including capitated payment models. Track 1 has no downside risk for first 3 years.
Track 2 has up and down side risk.
Pioneers – a responsibility to teach the world what works. Slow change from Fee for Service models. Moving from Fee For Service needs additional capabilities such as Data Warehousing which is slowing adoption. CMS has an advanced payment model that helps organizations make the change to alternate risk-based cost models. Bundled payments and changes to hospital readmission payments will drive push to better care. Pioneer applicants came from across the country and was not limited to high cost areas. ACO program is not just about payment changes – but about care improvement. Also want to understand HOW the results were achieved. What works and how that can be incentivized through payment policy. CMS is trying to understand best practices. Five Star Private Plans will be reviewed for best practice to understand how they achieve their rating and how those practices can be spread to other plans. CMS has to be based on a shared savings model with re-baselining using processes that work.
Who do the savings belong to: the payer, physician or the patient? Recent CBO review and report indicated that past CMS tests had mixed results in the area of care coordination. The old traditional model of reporting took too long. This prompted congress to approve a more dynamic process to test, review and disseminate results.
CMS sees a lot of interest in payment reform models. The volume of interest tells them that they must scale up quickly. Projects are based around the notion that they can be scaled.