The Center for Medicare and Medicaid Innovation (CMMI) has released a request for information to design a future episode-based payment model.
The center is looking for feedback on questions related to care delivery, incentive structure alignment, clinical episodes, participants, health equity, quality measures and multipayer alignment, payment methodology and structure, and model overlap, according to the request.
Episode-based payment models intend to address inefficiencies in traditional Medicare fee-for-service beneficiaries, where providers are paid for each item or service. This leads to “volume over value and fragment care,” according to the request (PDF).
In traditional Medicare, providers are paid for each item or service, which drives "volume over value" and more fragmented care, CMMI said. However, bundling items into an episode of care model incentivizes providers to avoid duplicative and unnecessary services.
“Generally, these episode-based payment models have demonstrated reductions in gross Medicare spending, driven in large part by reductions in post-acute care spending or utilization, with minimal to no change on quality of care,” the request said.
Ultimately, the innovation center wants 100% of Medicare FFS beneficiaries, and most Medicaid beneficiaries, in an accountable care relationship by 2030. It is expected that a new episode-based payment model would be implemented no earlier than 2026.
Previous bundled payment programs launched by CMMI include Bundled Payments for Care Improvement and the Comprehensive Care for Joint Replacement. These models focused on acute inpatient and hospital outpatient episodes.
In 2021, the innovation center announced a strategy shift with the goal of having a healthcare system that achieves equitable outcomes and person-centered care. In November, CMMI released a report stating its desire to implement value-based care focusing on coordination between primary care doctors and specialists.