New CMS Programs in 2016 Continue to Encourage and Reward Quality Outcomes

The Centers for Medicare and Medicaid (CMS) is poised to launch several new initiatives in 2016 as well as end certain programs such as the meaningful use incentive program. Building on the goals of the U.S. Department of Health and Human Service set in 2015, the focus remains specifically on rewarding quality outcomes, not quantity of services.

Among the initiatives for 2016 are the Comprehensive Care for Joint Replacement model (CCJR) which will begin on April 1, 2016 in sixty seven geographic areas, and the expansion of Medicare Accountable Care Organizations which have added one hundred and twenty one new participants.

In addition to CCJR and expanding ACOs, at the beginning of January, CMS also announced a pilot project to improve patients’ health by addressing unmet social needs of patients. This program is called the Accountable Health Communities Model and is the first CMS Innovation Center model of its kind to step beyond clinical services and raise awareness of patients’ social needs. It will test whether screening for health-related social needs and subsequent referral of beneficiaries to social services will improve the quality and affordability of health care by reducing chronic conditions and bolstering a patient’s ability to manage conditions such as housing instability, hunger, and violence. The funding from the Affordable Care Act will enable up to forty-four award recipients called “bridge organizations” to screen patients for social and behavioral issues and connect them to community-based services or even help patients apply for certain assistance. The model will test three approaches: community referral, community service navigation, and community service alignment. These three approaches aim to increase beneficiary awareness of available community services, help high-risk patients access services, and align partners to ensure the availability and responsiveness of services. Entities such as hospitals and health systems, community-based organizations, higher education institutions, local governments, and tribal organizations may apply to become a bridge organization.

In addition, CMS announced last week that it will end its longstanding meaningful use incentive program. However, even though the CMS acting administrator, Andy Slavitt, stated that meaningful use will end, he indicated in a speech on January 11 that it will be replaced by the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA foreshadowed the end of meaningful use with its Merit-Based Incentive Payment System that incorporates the use of electronic health record technology as part of an assessment of physician performance. Providers can expect details on the new program replacing meaningful use within the next few months, but Mr. Slavitt mentioned four themes that will guide implementation:

• A focus on outcomes that are achieved, rather than rewarding providers for the use of technology;

• User-centered technology that supports physicians and allows providers to customize their goals so that technology companies can meet individual provider’s needs;

• The use of open interfaces so that applications, analytic tools, and connected technologies can share data securely; and

• Interoperability and collaboration among physicians and patients.

It should come as no surprise that CMS is continuing to roll out and replace programs to further the shift from fee-for-service to payment for quality outcomes. Some programs, like ACOs and the Accountable Health Communities Model, are voluntary, but others, like MACRA, will fundamentally affect the delivery of health care services, especially when tied to reimbursement. Therefore, it is becoming increasingly important for providers to focus on providing quality medical care and outcomes for their patients. The Accountable Health Communities Model also demonstrates that other initiatives from CMS in the future may extend beyond clinical care and emphasize a holistic approach to health and reducing health care costs.