CMS Looking At Quality Metrics To Get ACA Exchange Plans Into Value-Based Care

Affordable Care Act (ACA) marketplace officials are hoping to get more plans into value-based care arrangements as regulators hope to not just build on getting people covered, according to federal officials.

Officials with the Centers for Medicare & Medicaid Services (CMS) spoke Thursday at the Health Care Payment Learning and Action Network Summit on value-based care, and one of the key takeaways was how agency officials are pushing to align quality standards across government programs like Medicare, Medicaid and the ACA exchanges to spur greater investment in value-based care.

Agency officials said a lot of effort on the ACA’s insurance marketplaces has focused on enrollment and expanding coverage. The ACA exchanges boasted a record-high 14.5 million sign-ups for the 2022 coverage year, thanks in part to enhanced premium subsidies that are in effect through 2025.

“Right now, we’re at a high point in our marketplace and experiencing some momentum here that allows us to make sure that we are continuing to build the market but also focus on the outcomes we are delivering to our consumers,” said Ellen Montz, director of CMS’ Center for Consumer Information and Insurance Oversight.

While some plans do participate in value-based care arrangements, CMS is hoping to send a stronger signal to get plans involved.

“We’ve been having lots of discussions with those plans, [and we] have a foundational tool … that can be used for paying for value,” Montz said, referring to the quality metrics and quality rating system.

The agency is trying to align its quality metrics across the center’s various programs to send a signal to providers on where to focus their efforts.

“When people are rowing in the same direction … where providers can know here is a good place to invest in changing workflows … you can really move the needle on quality and provision of care,” said Meena Seshamani, director of Medicare at CMS.

This effort to align quality standards can also help ease administrative burden and with it provider burnout, which has been made much worse by the COVID-19 pandemic, she added.

There could also be further alignment on not just quality metrics but also data collection on improving equity.

To consider the factors that can impact health disparities, regulators must work “in concert with each other so that, again, resources are put to bear in the most effective way possible,” Seshamani said.

Several CMS programs are searching for ways to hold plans and providers accountable for health equity, including adding new requirements for data collection. The Center for Medicare and Medicaid Innovation, for instance, is requiring participants in its ACO REACH model to create an equity plan that identifies equity gaps and a strategy to close them.


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