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Why CMS is prioritizing value-based care and how healthcare companies can support this initiative

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Created upon enactment of the Affordable Care Act (ACA) in 2010, the Center for Medicare & Medicaid Innovation (CMS Innovation Center) was established to design, implement and test new healthcare payment and delivery models for Medicare and Medicaid. Managed by the Centers for Medicare & Medicaid Services (CMS), the CMS Innovation Center aims to achieve better care for patients, better health for our communities and lower costs through the improvement of our healthcare system.

At the end of 2021, the CMS Innovation Center released a strategy refresh to transform the delivery system, focus on equity, pay for healthcare based on value to the patient instead of volume of services provided, and deliver person-centered care that meets people where they are. The strategy includes five pillars to advance value-based care: drive accountable care, advance health equity, support care innovation, address affordability and partner to achieve system transformation.

To help CMS achieve this 10-year goal, healthcare companies must create and implement strategies today to support and advance the five mentioned pillars. An important tool for this journey is the continued use of AI technology and machine learning in the healthcare system.

Thanks to the 1996 Health Insurance Portability and Accountability Act (HIPAA) that created federal standards guaranteeing patients the right to access their health data while maintaining patient privacy, we now have the opportunity to leverage patient data in a way that advances value-based care.

If they’re not already, healthcare companies need to begin training their AI technology with the CMS Innovation Center’s long-term goals in mind to continually educate and activate patients. Here is where these changes can and must happen.

Drive accountable care

To drive accountable care through increased beneficiaries, families need efficient and trustworthy resources to turn to for answers. Implementing technology that will allow patients and their family care advocates to review a patient’s health history or receive alerts anytime a health change occurs can make this possible while also minimizing repeated efforts and total cost of care. With this data, families will be more engaged and can better collaborate on a family member’s health concerns.

Advance health equity

A survey published in BMC Public Health revealed that not only are a majority of Americans unaware of health disparities, but they don’t understand these health gaps and don’t find them unfair.

In order to advance health equity and increase focus on underserved populations, we need AI-driven companies with built-in risk assessment capabilities, which can organically support an accountable care model. This requires a deep data analysis and patient engagement reporting capabilities to identify gaps in service and provide a feedback loop to care providers and plans where deficiencies exist.

Support care innovation

To support care innovation, personalized care must be a top priority. Through leveraging outcomes data aggregated from a vast pool of patients with similar situations and diagnoses, AI has the potential to share recommendations that are pertinent to individual patients. This enables person-centered care by focusing only on messaging and suggestions that truly matter for each individual and eliminating noise and misinformation.

Improve access by addressing affordability

Affordability is crucial to improving patient access to care. According to the National Academy of Medicine, unnecessary tests and procedures increase healthcare costs by an estimated $765 billion every year. By training AI technology to review outcome-based, historical healthcare data, companies can deliver customized guidance for cost-efficient healthcare options.

This addresses affordability by reducing prices through alternative options for lower cost scans, tests and prescription medicines and could eliminate repeat visits, unnecessary tests and procedures.

Partner to achieve system transformation

The partnership needed to accomplish this fifth pillar of CMS’s strategy requires all parties to collaborate including payers, purchasers, providers, states and beneficiaries. To form such an alliance will require predictive data analysis to both harness and provide healthcare guidance and identify inefficiencies in the care delivery continuum.

As we reflect on the past 10 years of the CMS Innovation Center, we are reminded that the road to value-based care is evolving as technology advances. CMS needs the support of companies who create and implement solutions that are moving society toward care models and compensation packages centered around health outcomes with a high focus on better patient engagement and education

Photo: atibodyphoto, Getty Images

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