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Fully risk-based payment models likely to decrease, CMS official says

Those working in healthcare should not expect many more fully risk-based payment models from the Center for Medicare and Medicaid Innovation (CMMI), CMS Chief Operating Officer Jon Blum said during the National Association of Accountable Care Organizations’ fall conference.

“I don’t think that CMS will be promoting models that have more risk just for the sake of having more risk,” Blum said. “We know that when we [incentivize] risk, we see some downsides to that…We see stronger incentives for more diagnosis code submissions, some of which might be appropriate, some of which not.”

While CMS has offered payment models that require providers to take on a high level of risk, the Next Generation Accountable Care Organization model, one of the high-risk models, was removed. According to Blum, however, that doesn’t mean that CMS won’t adopt any high-risk models.

“We want the healthcare system to be much more equitable, and we want to see people better,” he says. “Our innovation center has brought forward the observation that the models we are currently running tend to involve those communities that are higher income, that are disproportionately white.”

The agency also has an overall vision to simplify the number of models available. With so may different models, CMS has lost sight of its overall vision and what they really care about, Blum noted. While the right course in the past may have been to have many models, now what makes the most sense is to offer a simplified option set.

Shared from the Association of Clinical Documentation Improvement Specialists