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Your value-based care roadmap for 2022


Primary care providers (PCPs) have faced many challenges during the pandemic. Healthcare delivery methods suddenly had to become more innovative to keep everyone safe and many independent practices have suffered the financial strain as a result of the disruptions caused by COVID-19. Regrouping and refocusing on the longer term will become important elements of your value-based care roadmap for 2022.

The future for PCPs and value-based care will depend on an ability to adjust to innovations and updates in the program promoted by the Centers for Medicare & Medicaid Services (CMS). Some experts believe that the concept and the practical features of value-based care are at a crossroads going into 2022, even though the payment models continue to be viewed as effective methods for addressing the rising costs of healthcare.

CMS has made some changes in response to the challenges faced by providers during the pandemic. The Medicare Shared Savings Program (MSSP) has paused new accountable care organization (ACO) entrants and there has been a delay in the move to two-sided risk. Some of the most recent advanced payment reforms have also been delayed.

At the same time, CMS has re-emphasized its commitment to value-based payment and to care transformation overall. In an Innovation Center Strategy Refresh, the organization focuses well beyond 2022, with a renewed vision moving forward to 2030. The roadmap for PCPs and value-based care should align with this renewed vision for long-term sustainability.

In its whitepaper, CMS established its commitment to five strategic objectives and to measuring progress against defined metrics. The organization notes that this commitment will “guide revisions to existing models and the development of a more streamlined portfolio that can drive broad system transformation.”

An emphasis on deeper collaborations, advancing access to value-based care for underserved populations, and data sharing permeate the long-term vision. The role of PCPs and value-based care are rooted in the contribution to building a health system of the future that achieves equitable outcomes through high-quality, affordable, person-centered care.

A roadmap for 2022 will focus on the five strategic objectives outlined in the Innovation Center Strategy Refresh:

Drive Accountable Care. The aim of this objective is to increase the number of people in a care relationship with accountability for quality and total cost of care. The goal is for all Medicare beneficiaries with Parts A and B to be in a care relationship with accountability for quality and total cost of care and for the vast majority of Medicaid beneficiaries to be in a care relationship with accountability for quality and total cost of care by 2030.

Advance Health Equity. This objective is aimed at embedding health equity in every aspect of CMS Innovation Center models and increasing the focus on underserved populations. As a result, all new models will require participants to collect and report the demographic data of their beneficiaries and, as appropriate, data on social needs and social determinants of health. In addition, providers should identify areas for reducing inequities at the population level, such as avoidable admissions, and set targets for reducing those inequities.

Support Care Innovations. Setting targets to improve performance on patient experience measures, measures that assess health promotion and education, shared decision-making, and care coordination, this objective will leverage a range of supports that enable integrated, person centered care such as actionable, practice-specific data, technology, dissemination of best practices, peer-to-peer learning collaboratives, and payment flexibilities.

Improve Access by Addressing Affordability. Healthcare costs continue to increase and so this objective aims to pursue strategies that will address affordability and that will reduce unnecessary or duplicative care. The progress measurement will focus on setting targets to reduce the percentage of beneficiaries who forgo care due to cost by 2030. All models will consider and include opportunities to improve affordability of high-value care by beneficiaries.

Partner to Achieve System Transformation. Improving quality, achieving equitable outcomes, and reducing healthcare costs are the goals of aligning priorities and policies across CMS as the organization engages payers, providers, patients, and other stakeholders. New models will be encouraged to make multi-payer alignment available by 2030, collecting and integrating patient perspectives across the life cycle.

Going forward, as a roadmap for 2022 and beyond, PCPs and value-based care will have a more intentional focus on addressing health disparities and on ensuring equitable access, quality, and outcomes.