« Posts

Competition and Value Lead CMS Policy Priorities

The head of CMS outlined the agency’s policy shift to competition and choice in a recent interview.  Seema Verma noted, “Coming incentives will encourage Medicare beneficiaries to shop among providers, with those that have the lowest prices and deliver better-coordinated care gaining a competitive advantage.” (“Public Poll, Verma Reject Single-Payer,” HFMA Compass, July 27, 2018)


Specific points made in her interview include:


  • “Patients are the most valuable force in our healthcare system to create value,” emphasizing the need to cater to patients, “not providers.”
  • All levels of CMS should drive a system where providers compete for patients.
  • Pricing and clinical outcomes’ transparency is required to allow patients to shop; e.g., posting online the full chargemaster price list
  • Patients should be able to access and share their electronic health record—CMS has suggested that providers may be required to share all patient’s electronic health records as a condition of participation in Medicare.
  • CMS will “double down” on value-based payments.


She also noted that the president “believes competition is the key ingredient to drive down healthcare spending.” (“Public Poll, Verma Reject Single-Payer,” HFMA Compass, July 27, 2018)


Value-based Care Models


Ms. Verma criticized the Obama administration’s approach to value-based care models. She listed three specific shortfalls:


  1. The models overlooked the patient—providing incentives for providers but neglecting to empower the patient.
  2. Most payment models were set up to encourage consolidation in the marketplace. She noted that consolidation actually reduces competition.
  3. The models did not go far enough to make providers responsible for their own budgets.


She criticized one-sided risk models and claimed that “those are not the most effective way.” She said the industry needs models that will encourage the provider to take responsibility for the budget.


To increase Medicare provider participation in value-based payment arrangements, she said she plans to waive more program integrity rules and offer new models for primary care physicians. (“Public Poll, Verma Reject Single-Payer,” HFMA Compass, July 27, 2018)




The Volume to Value Paradox advanced Quality course, featuring Nate Kaufman, Marian Jennings and Dan Grauman, is in your library. These experts discuss their perspectives of moving from volume to value, the pitfalls to avoid, how to involve physicians, the impact of consolidation and scale on value and the overall challenges of inserting value into the reimbursement formula.


Our upcoming course focuses exclusively on costs and both traditional and innovative approaches to cost reduction. Look for it soon in your library!



For a complete list of iProtean, now part of Veralon courses, click here.



For more information about iProtean, now part of Veralon, click here.