OVERVIEW

In this session, McDermott Will & Emery partner Matthew Perreault moderated a panel that discussed the current state of value-based care in original Medicare and lessons learned from the panelists’ experiences with various Center for Medicare & Medicaid Innovation (CMMI) models.

Session panelists included:

• Rob Cetti, President, CareAllies
• Stanley D. Crittenden, MD, FASN, CHS, Chief Medical Officer, Evergreen Nephrology
• Tim Gronniger, Chief Value-Based Solutions Officer, Signify Health
• Matthew Perreault, Partner, McDermott Will & Emery
• Kim Phan, Chief Executive Officer, CareConnectMD

IN DEPTH

Top takeaways included:

1. When evaluating participation in CMMI models, stakeholders should recognize that the models are focused on innovation and may be more susceptible to redesign and changes in CMMI priorities than Medicare Shared Savings Program (MSSP) models. Participants in CMMI value-based care models must be ready to engage with changes that will impact revenue. The desire of the Centers for Medicare & Medicaid Services (CMS) to build around full-risk models and streamline benchmarks may have larger-than-anticipated economic impacts for stakeholders with conservative investment views.
2. High-needs populations under the Accountable Care Organizations Realizing Equity, Access, and Community Health (ACO REACH) and specialty models, such as the Comprehensive Kidney Care Contracting model, offer an opportunity to address historically neglected patient populations. To succeed, companies must align with physicians to ensure that their physicians understand and employ the right tools to improve the quality measures that CMS establishes, such as patient activation measures, and foster patient engagement.
3. In contrast to the widespread adoption of ACO participation by primary care providers, many specialty providers still are not participating in CMMI models. Rather than waiting for CMMI to create attractive value-based payment models to increase specialty provider participation, some entrepreneurial physicians are seizing the opportunity to create unique business models, and craft value-based payment structures with local plans, that work for their patient demographics.