3.4: Payment Reform
AGGRESSIVELY IMPLEMENT AND EXPAND PAYMENT REFORM PILOTS. Other Information:
Direct CMS to design and begin implementation of Medicare payment reform pilots, demonstrations, and programs as rapidly as
possible and allow successful programs to be expanded without further congressional action. The Affordable Care Act requires
CMS to conduct a variety of pilot and demonstration projects in Medicare to test delivery system reforms which have the potential
to reduce costs without harming quality of care. These pilots include Accountable Care Organizations (ACOs), bundling for
post-acute care services, and other programs to pay for performance. We recommend CMS be directed to aggressively pursue these
and other reforms, including introduction of downside risk to ACOs and bundled payment pilots. CMS should also ensure that
the private sector is an active partner in the research and design of payment reforms, building on concepts that have been
proven to work at the state, regional, or federal level. In addition to Medicare pilots, we recommend that CMS be required
to fast-track state Medicaid waivers that offer demonstrable promise in improving care and returning savings, such as Rhode
Island’s Global Consumer Choice Demonstration, which provides a capped federal allotment for Medicaid over five years; Vermont’s
all-payer advanced primary care practice reform, called Blueprint for Health; and Community Care of North Carolina, a provider-led
medical home reform that has increased access to primary care, decreased emergency department usage, and saved money. Pilots
that succeed in controlling costs should be expanded as rapidly as is feasible. The Commission recommends shifting the presumption
toward expanding reforms by requiring the Secretary to implement any pilot projects that have shown success in controlling
costs without harming the quality of care by 2015. The Commission recommends utilizing the new Center for Medicare and Medicaid
Innovation as the vehicle for accelerating these pilots. The Commission’s plan does not assume any savings from expansion
of these pilot projects in its deficit estimates, but believes that there could be substantial savings in Medicare, Medicaid,
CHIP, and other health from aggressive implementation of successful pilots.
Indicator(s):
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