Accelerating care delivery transformation — the CMS innovation center’s role in the next decade

In assessing more than 10 years of value-based payment models, the U.S. Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation identified three themes that will inform new approaches to iterative learning, evaluation, and systematic assessment of strategies and interventions that are most effective at improving quality and care for patients. Over the past decade, the U.S. Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMS Innovation Center) has tested more than 50 payment models with a range of participants and value-based payment features. Value-based payment models can provide the necessary flexibility to support care delivery that better addresses people’s health and health-related social needs. This transformation of the delivery system, supported by value-based payment models, can drive better care, improve outcomes, and lower costs. The impact of CMS Innovation Center models has largely focused on financial impacts, with varied results in terms of total health care cost reduction. There has been less focus on the extent to which payment models have enabled care delivery transformation. To inform the development of a new framework to better assess the impacts of payment models and to drive care delivery transformation, the CMS Innovation Center undertook a retrospective review and synthesis of select models to assess if — and which — care delivery changes have been observed. The review indicated demonstrable evidence of enhanced care delivery in several areas, such as care coordination, team-based care, and leveraging data to risk-stratify patients, among other strategies. Three broad themes are shared among the more successful efforts. (1) Participants across models used common care coordination and other strategies to deliver person-centered care, (2) practice changes enabled by value-based care models showed evidence of tailoring care to local needs, and (3) care delivery trends and changes extend beyond the CMS Innovation Center models. This article summarizes those findings, which are informing the development of a new framework to accelerate care transformation.