Medicaid in 2022: CMS Eyes Equity, Value-Based Care | Deloitte US has been saved
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By Jim Hardy, specialist executive, State Health Transformation Services, Deloitte Consulting LLP
A decade has passed since the Centers for Medicare and Medicaid Services (CMS) launched the Center for Medicare and Medicaid Innovation (CMMI). What’s ahead for the next 10 years? There will likely be greater emphasis on using CMMI to drive meaningful change toward health equity and value-based care, according to a statement from CMS administrator Chiquita Brooks-LaSure. Based on a recent white paper (the Innovation Center Strategy Refresh) it appears that CMS will likely expand pilots that have shown promise and shelve smaller initiatives that haven’t met expectations.
The strategy refresh could be critical for rapidly expanding social programs. Between February 2020 and May 2021, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by 11.5 million—nearly 83 million people are now covered by those two programs. The enrollment increase was likely fueled by the COVID-19 pandemic. The proposed $2.2 trillion budget-reconciliation bill could further expand enrollment by addressing coverage gaps for people who live in states that opted not to expand Medicaid eligibility.
I expect Medicaid programs will continue to emphasize ways to improve primary care and advance total-cost-of-care models. CMMI has indicated that it wants to work more closely with states to improve health equity and to move Medicaid toward value-based care. We also could see an increased focus on multi-payer alignment on alternative payment models (APMs), with more collaboration between Medicaid and Medicare. The ability to align and (at a minimum) harmonize on these initiatives will likely be a critical step in helping to reduce provider burden and hesitancy in transforming clinical and operational models to improve patient outcomes in a financially viable way.
Bringing a health equity focus to value-based care will likely be another major theme. CMMI and most states share a commitment to address equity in value-based design and goals. It will be interesting to see how this increased focus on equity will translate into specific initiatives and how health equity will be imbedded in broader initiatives.
I see three significant opportunities for state Medicaid programs coming out of CMMI’s “refreshed” strategy:
To take advantage of CMMI’s refreshed strategy, many state Medicaid programs will likely need to:
CMMI and state Medicaid programs have come along way over the past 10 years to advance value and outcomes in the health care system. As we emerge from the profound effects of the COVID-19 pandemic, I am hopeful more progress can be made in improving health equity and that the partnership between CMMI and state Medicaid programs can grow stronger.
1. MaineCare Accountable Communities Overview, Maine Department of Health and Human Services, May 10, 2021
Jim is Deloitte Consulting LLP’s Medicaid Advisory Services lead. Previously Pennsylvania’s Medicaid director, he has more than 20 years of Medicaid, health policy, reimbursement and rate development experience. Recently, Jim assisted in developing a state Medicaid care management strategy and long-term care reform strategy; assisted states with coverage initiatives; and led a hospital payment reform initiative for quality incentives and to reduce payment for avoidable re-admissions.