CMS Official: Don't expect a lot of fully risk-based payment models going forward

Fierce Healthcare
Don’t expect a lot more fully risk-based payment models from the Center for Medicare and Medicaid Innovation (CMMI), a top official said.
Centers for Medicare & Medicaid Services Chief Operating Officer Jon Blum detailed the agency’s vision for value-based care during the National Association of Accountable Care Organizations' fall conference Thursday.
“I don’t think that CMS will be promoting models that have more risk just for the sake of having more risk,” said Blum.
Although Blum said it is still important to have risk-based models, there are data that show downsides of full-risk payment models.
“We know that when we [incentivize] risk we see some downsides to that,” Blum said. “We see stronger incentives for more diagnosis code submissions, some of which might be appropriate, some of which not.”
Another concern is when you have “more transformation towards risk that tends to favor those who are better capitalized and can afford risk,” he added.
ACOs agree to take on a share of financial risk and meet spending and quality benchmarks. ACOs that don’t meet the benchmarks will have to repay Medicare but will get a share of savings if they do.
CMS has offered payment models that require providers to take on a high degree of risk. However, one of those models, the Next Generation ACO model, was sunset by the Biden administration.
Blum said that doesn't mean CMS won't adopt any high-risk models.

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