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During the first year of the Trump administration, states have grappled with many unanswered questions regarding the new administration’s views on value-based payments (VBPs) and how it would approach state-led or Medicaid based payment reform initiatives. These include to what extent existing efforts will continue to be supported or renewed, what mechanisms states can or should use to implement VBPs (e.g., DSRIP programs, 1115 waivers, 1115A waivers), what financial support will be available, and how much flexibility the Center for Medicare & Medicaid Services (CMS) will grant states in designing and funding innovative models. In the past eight months, CMS has revealed what it will look for in these initiatives moving forward, such as a desire to support state innovation. This paper provides a historical perspective on VBPs, including the health care system’s move away from payment models based on fee-for-service, and an overview of state models focused on value and quality. The paper also outlines the Trump administration’s key signals to date and how they might impact state VBP efforts in 2018 and beyond.
As health care spending in the U.S. reaches unsustainable levels, the value-based reform movement seeks to rein in costs and improve quality. Amid these reform efforts, it is necessary to assess the current state of health care and how different stakeholders approach health care’s challenges and solutions. Leavitt Partners surveyed physicians, employers, and consumers across the nation to better understand their perspectives in today’s complicated, challenging, and changing health care system. Physicians, employers, and consumers all agree that fundamental changes are needed to make the U.S. health system work better; however, physicians and employers disagree on which payment reform efforts will work, who is responsible for driving reform, and which are the most important barriers to overcome. Consumers express the need for fundamental, systemic changes to the health care system, yet report satisfaction with their individual health care, including their health insurance plan. Understanding where these groups agree and disagree enhances our knowledge of the state of health care today and the best next steps for tomorrow.
Dual-eligible enrollees account for a disproportionately sizeable proportion of spending in both Medicare and Medicaid programs. However, until recently, these nearly 11.5 million[i] enrollees have not been in the spotlight in discussions regarding the move toward value-based payments.
Background The Centers for Medicare and Medicaid Services (CMS) has initiated a process whereby physicians and other stakeholder entities can design physician-focused payment models (PFPMs) that fit with their clinical practices, while also providing better outcomes for patients, and recommend such models to the Health and Human Services Secretary (the Secretary) for consideration and/or further […]