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HHS gets to value-based reimbursement goal ahead of schedule

In a 'major milestone' for the Affordable Care Act, 30 percent of Medicare payments are now made through alternative payment models.

Mike Miliard, Editor, Healthcare IT News

HHS Secretary Sylvia Burwell speaking at HIMSS16 earlier this week.HHS Secretary Sylvia Burwell speaking at HIMSS16 earlier this week.

Barely a year after announcing its ambitious plan to tie reimbursement to quality of care, the U.S. Department of Health and Human Services announced March 3 that 30 percent of Medicare payments are now tied to alternative payment models, such as ACOs.

The goal was reached nearly a year ahead of schedule, according to HHS, which touts the fact that more than 10 million Medicare patients are now getting higher-quality and more coordinated care.

In January 2015, HHS set big goals to move 30 of Medicare to value-based arrangements by the end of 2016. With 121 new ACOs announced in January, along with higher provider participation than expected in other alternative payment programs, the agency says it has already achieved it.

It's thanks in large part to Affordable Care Act-enabled initiatives such as the Medicare Shared Savings Program and the Center for Medicare and Medicaid Innovation, which allowed for the testing of new cost- and quality-conscious APMs, said HHS Secretary Sylvia Burwell.

"Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to health care," said Burwell in a statement. "The law gives us the tools to put patients at the center of their care, improve quality and help make care more affordable over the long term."

At HIMSS16 this week, more than 40,000 healthcare professionals from around the country gathered in Las Vegas, many of them here to learn about technologies and strategies that can help them achieve the benchmarks necessary for value-based payment models: interoperability tools for more coordinated and connected care, data analytics for population health, patient engagement technology and more.

"We reached this goal in partnership with the thousands of providers who collaborated with us in innovation," said Patrick Conway, MD, deputy administrator for innovation quality and chief medical officer at CMS, in a statement. "It's in our common interest – as patients, providers, businesses, health plans, taxpayers – to build a health care delivery system that delivers better care; spends health care dollars more wisely; and makes individuals and communities healthier."

There are 477 Medicare ACOs participating in the Shared Savings Program and the Pioneer ACO Model combined  In 2014, these programs generated a total net savings of $411 million. ACOs represent about three quarters of progress toward the goal announced today, according to HHS, which says these gains will continue to increase over the course of the year, with the start of the Comprehensive Care for Joint Replacement model and the Oncology Care Model in 2016.

Today's estimates were evaluated by the independent Centers for Medicare & Medicaid Services Office of the Actuary, which multiplied the number of Medicare beneficiaries in alternative payment models by the expected cost of their care, then comparing that figure to projected Medicare fee-for-service spending. As of January 2016, CMS estimates roughly $117 billion out of a projected $380 billion Medicare fee-for-service payments are tied to APMs.

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