CMMI Payment Models

• Sessions will Provide Input for CMMI Staff on Key Policy Issues
• CMMI staff will join in watch/listen-only mode
• Listening Session I: How Can ACO and Specialty Models Co-exist?
  • Monday, September 20, 2021 from 3:30 pm to 5 pm EDT
  • Moderated by Francois de Brantes, MBA, SVP, Signify Health & Valinda Rutledge, MBA, EVP Federal Affairs, America’s Physician Groups (APG)
• Listening Session II: Supporting Primary Care Practices in Value-Based Care: Improving Primary and Specialty Care Collaboration within Federal Initiatives
  • Wednesday, September 22, 2021 from 3:30 pm to 5 pm EDT
  • Moderated by Richard J. Baron, MD, President & CEO, ABIM Foundation & Valinda Rutledge, MBA, EVP Federal Affairs, America’s Physician Groups (APG)
• Listening Sessions supported by a Grant from the Commonwealth Fund
• Media Partner: Health Affairs
• www.ValueBasedPaymentSummit.com

REGISTRATION DETAILS

• Click here to register for Listening Session I
• Click here to register for Listening Session II
• Registration now only available for “Chat Participation”
• You will be participating in listen/watch-only mode with the ability to ask written questions and to offer written comments via the zoom chat function
• To register, individuals will provide basic personal information and are urged to provide brief written comments on the Listening Sessions discussion issues/questions. Said comments may be made anonymously at the choice of the attendee.
• Note that CMMI a staff will receive copies of all registration comments and text messages shared during the Listening Session.

LISTENING SESSION I: HOW CAN ACO AND SPECIALTY MODELS CO-EXIST?

• Monday, September 20, 2021 from 3:30 pm to 5 pm EDT
• Moderated by Francois de Brantes, MBA, SVP, Signify Health & Valinda Rutledge, MBA, EVP Federal Affairs, America’s Physician Groups (APG)
• Issues to be discussed:
  • Have you had success involving specialists? If not, what barriers have you experienced integrating single specialty and/or multi-specialty practices? If so, what does success look like?
  • Are there certain specialty areas where you can influence costs as opposed to others, where you can’t? If so, which areas and why?
  • Does this differ for procedure episodes (e.g. hip or knee surgery) compared to complex, chronic medical conditions (e.g. cardiac care, oncology care)?
  • How would you handle overlap if a distinct specialty model co-exists with an ACO? How would you avoid duplicate payments, as well as disincentives to join the models?
  • Have any barriers prevented your involvement in total cost of care initiatives? If so, what would need to change to facilitate your involvement?
  • If a specialty-focused model co-exists with a total cost of care model, how would you handle overlap? Do you have concerns with sharing risk?
  • Is it possible to appropriately incentivize or encourage participation from both specialists and TCOC entities to engage in an integrated care model, such that sharing risk is not a point of competition? Or Can the specialty care models be replaced by total cost of care models?
  • What examples exist of TCOC entities doing exceptional work to align clinical and financial incentives with specialty care?

LISTENING SESSION II: SUPPORTING PRIMARY CARE PRACTICE IN VALUE-BASED CARE: PRIMARY CARE ACCOUNTABILITY FOR SPECIALTY CARE WITHIN FEDERAL INITIATIVES

• Wednesday, September 22, 2021 from 3:30 pm to 5 pm EDT
• Moderated by Richard J. Baron, MD, President & CEO, ABIM Foundation & Valinda Rutledge, MBA, EVP Federal Affairs, America’s Physician Groups (APG)
• Issues to be discussed:
  • When have advanced primary care initiatives had success involving specialists? What did that success look like and how did they overcome the many known barriers to integrating care?
  • In which specialty areas are advanced primary care practices more likely to influence costs and utilization effectively? Which specialty areas show less ability to be influenced by primary care, and should that be changed?
    • Does this differ for procedure episodes (e.g. hip or knee surgery) compared to complex, chronic medical conditions (e.g. cardiac care, oncology care)? How about regions and practice types (IPAs, multi-specialty orgs, hospital-based health systems)?
    • How does being part of an ACO make this work more or less effectively?
  • Are there specific components of existing specialty-focused models that impair incentives to coordinate a beneficiary’s care with primary care?
  • How would you handle overlap if a distinct CMMI specialty model co-exists with an advanced primary care model?
    • How would you avoid duplicate payments?
    • How to handle disincentives to participate in the models?
    • Do you have concerns with sharing risk?
    • Do the models need more coordination between them, and how would that happen?
  • Should we avoid building new specialty-focused care models in favor of more broad or global organizational models? What are the trade-offs?
  • Is it possible to appropriately encourage participation from both specialists and advanced primary care models to engage in an integrated care model? How does that differ from ACO models?
  • What quality metrics provide incentives for better primary/specialty care coordination?
  • What flexibilities in Medicare program/payment rules would help improve coordination between primary and specialty care?