Azar: Advancing value-based agenda 'is going to mean mandatory models'

The Center for Medicare and Medicaid Innovation will soon launch "new, bold" models for value-based care — and they might be mandatory, according HHS Secretary Alex Azar's remarks at a Sept. 6 meeting in Washington, D.C., for the Physician-Focused Payment Model Technical Advisory Committee.

Despite the growth in coordinated care and value-based pay, alternative payment models have produced lackluster results so far, Mr. Azar said, citing a CMS report that found ACOs have not delivered significant savings after taking all costs and incentives into account.

"Without real accountability, we're just offering bonuses on top of payments that may be too high already. That's why we have now proposed to simplify the ACO system into two tracks, requiring them to take on risk sooner," Mr. Azar said. Among ACOs, the best results have been driven by both those in two-sided risk tracks and physician-led models. On Aug. 9, the agency proposed a new rule that would overhaul the Medicare Shared Savings Program and push ACOs into two-sided risk sooner.

In addition to these changes, providers should be ready for CMMI to roll out mandatory pilots, Mr. Azar said. "In some cases, as I've said before, that is going to mean mandatory models from CMMI and other mandatory reforms. Requiring participation can be necessary to determine whether a model really works, but it may also be necessary to meet what we see as an urgent need for reform," Mr. Azar said.

As early as his confirmation hearings, Mr. Azar voiced support for mandatory testing, in sharp contrast with Tom Price, MD, the previous HHS secretary under President Donald Trump. During his tenure, Dr. Price canceled and scaled back major mandatory bundled payment initiatives.

However, Mr. Azar promised the agency would not overstep. "We are not going to be overzealous in determining how these reforms happen. We're interested in driving the outcome we want, rather than micromanaging how you get there."


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