CMS Issues New Guidance for States Adopting Value-Based Care Strategies

September 28, 2020

The Centers for Medicare & Medicaid Services (CMS) recently issued new guidance for states adopting value-based payment (VBP) programs and broader value-based care (VBC) initiatives. The guidance may affect future variations of Medicaid’s VBP program and related updates to New York State’s VBP Roadmap, and is based on experiences and lessons learned from the CMS Innovation Center’s health care payment and service delivery model reforms. It includes approaches for developing statewide VBP methodologies alongside CMS, aligning provider incentives across payers, and pathways for adopting the various approaches.

CMS encourages states to adopt VBP and VBC in the context of their experience with advanced payment and delivery models. The guidance describes levels of financial risk, benchmarking, and payment operations as three critical elements of these models. It also details considerations for driving successful shifts to VBP, including delivery system readiness, health information exchange capabilities, stakeholder and community-based organization engagement, quality metric selection, and sustainability. New York State prioritized many of these considerations in its current VBP Roadmap. In addition, the guidance discusses multi-payer alignment and supports efforts to align Medicaid payment models with Medicare and private payers and includes pathways to adopt these payment models, including those promoting VBP strategies under fee-for-service and managed care.

CMS’s guidance is intended to reduce the burden on providers who participate with multiple payers and result in better rewards for delivering quality care. GNYHA will continue to keep its members apprised about VBP payment reform activities.