CMS issues new roadmap to accelerate adoption of value-based care for Medicaid beneficiaries

Sept. 17, 2020

The Centers for Medicare & Medicaid Services (CMS) reported in a press release that it has issued guidance to state Medicaid directors designed to advance the adoption of value-based care strategies across their healthcare systems and align provider incentives across payers. 

Under value-based care, providers are reimbursed based on their ability to improve quality of care in a cost-effective manner or lower costs while maintaining standards of care, rather than the volume of care they provide. Value-based care arrangements may also permit providers to address social determinants of health, as well as disparities across the healthcare system. Moving toward a more value-driven healthcare system allows states to provide Medicaid beneficiaries with efficient, high quality care, while improving health outcomes. Value-based care may also help ensure that the nation’s healthcare system is better prepared and equipped to handle unexpected challenges, including the ongoing COVID-19 pandemic. 

This guidance includes an assessment of key lessons learned from early state and federal experiences in implementing value-based care reforms, as well as a comprehensive toolkit of available federal

authorities for states to adopt innovative payment reform efforts within their individual programs. It stresses the importance of multi-payer alignment in value-based care to drive care transformation and supports state efforts to align new payment models in Medicaid with Medicare and other private payers. 

CMS has made a strong commitment to advancing value-based care in Medicare for its 61.7 million enrollees. This guidance is designed, with the understanding that many of the providers overlap, to ensure that this same commitment can be made at the state level through Medicaid with its nearly 74 million beneficiaries by aligning strategies and common understanding of effective approaches. While these programs serve different populations, they share common goals of lower costs and improved health outcomes, and reduce burden if payers are aligned with value-based care. 

CMS has the release. 

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