The Centers for Medicare & Medicaid Services (CMS) aims to transition all Original Medicare and most Medicaid beneficiaries into accountable care relationships by 2030. This shift necessitates innovative tools and models for value-based specialty care, particularly in cardiology, where fragmented and costly care is prevalent. This article explores the critical need for value-based care cardiology tools and examines CMS’s strategic approach to fostering their development and implementation.
The Urgent Need for Value-Based Cardiology Tools
Medicare beneficiaries often experience fragmented care, characterized by numerous diagnostics, imaging, tests, and treatments from various specialists. This fragmentation leads to increased costs and potential inefficiencies. Similarly, Medicaid beneficiaries encounter access barriers to specialty care, particularly in cardiology, due to factors like low specialist payment rates and limited network coverage. Market consolidation, particularly in cardiology, further complicates the issue by potentially increasing costs without commensurate quality improvements.
Figure 1: Aligned Elements of the Specialty Strategy and Beneficiary Care Experience.
CMS’s Strategic Approach to Value-Based Cardiology Care
Based on learnings from previous models and expert input, CMS has developed a comprehensive specialty care strategy focused on:
Enhancing Transparency of Specialist Data
Increased transparency of specialist performance data, including cost and quality metrics, is crucial. Sharing this data with primary care providers empowers them to make informed referral decisions, guiding patients toward high-value cardiologists. CMS is exploring ways to refine existing data and develop standardized episode definitions to facilitate comparisons and accountability.
Maintaining Momentum on Episode Payment Models
Building on the success of existing episode-based payment models like BPCI Advanced, CMS plans to extend these models and develop new ones focused on specific conditions like cancer. A mandatory episode payment model is also under consideration to further standardize care and reduce risk selection. These models incentivize collaboration between specialists and primary care providers, promoting coordinated care for cardiology patients.
Integrating Specialists into Primary Care Pathways
Integrating specialists into primary care delivery pathways, especially for complex conditions, can improve coordination and reduce fragmentation. Strategies include incentivizing the use of e-consults to avoid unnecessary referrals and potentially exploring capitated payments to specialists within population-based models. This integration can facilitate timely access to specialized cardiac care while reducing overall costs.
Creating Financial Incentives for Specialist Engagement
Aligning financial incentives for specialists to participate in value-based care models is essential. This could involve adjusting beneficiary alignment algorithms to include specialty care services and developing subpopulation targets for high-volume conditions like cardiovascular disease. These incentives encourage cardiologists to actively manage patient populations and prioritize quality outcomes.
| Key Learnings | Aligned Element of Specialty Strategy |
|---|---|
| Providing data on specialist performance and enhancing data sharing across practices would facilitate integration with primary care and ACOs. | Element #1: Enhance transparency of specialist data and performance measures to increase access to high-quality, accountable specialty care and integration with primary care. |
Conclusion: The Future of Value-Based Cardiology
CMS’s multifaceted strategy aims to revolutionize specialty care delivery, particularly in cardiology. By enhancing data transparency, refining payment models, integrating specialists into primary care, and aligning financial incentives, CMS seeks to promote high-quality, coordinated, and cost-effective cardiac care for all beneficiaries. These value-based care cardiology tools hold the potential to significantly improve patient outcomes and transform the future of cardiovascular care.
