Strategic Direction

Aim: Increase the number of beneficiaries in a care relationship with accountability for quality and total cost of care.

Accountable care reduces fragmentation in patient care and cost by giving providers the incentives and tools to deliver high-quality, coordinated, team-based care. Models should increase the number of beneficiaries in accountable care relationships with providers, such as advanced primary care providers and ACOs. Quality of care and outcome measures should be measures that matter and include patient values and perspective.

Measuring Progress:

• All Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.
• The vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.

Aim: Leverage a range of supports that enable integrated, person-centered care - such as actionable, practice-specific data, technology, dissemination of best practices, peer-to-peer learning collaboratives, and payment flexibilities.

The CMS Innovation Center will test approaches to close care gaps and deliver whole-person care by driving progress in areas like integrated care, behavioral health and social determinants of health. Work in this pillar also includes leveraging data, technology, and payment flexibilities to enable care in homes & communities.  

Measuring Progress:

• Set targets to improve performance of model participants on patient experience measures, such as health and functional status, or a subset of Consumer Assessment of Healthcare Providers and Systems (CAHPS®, a registered trademark of the Agency for Healthcare Research and Quality) measures that assess health promotion and education, shared decision-making, and care coordination.
• All models will consider or include patient-reported outcomes as part of the performance measurement strategy for the CMS Innovation Center.

Aim: Pursue strategies to address health care prices, affordability, and reduce unnecessary or duplicative care.

The CMS Innovation Center will pursue strategies to address health care prices, affordability, and reduce waste. It seeks to address affordability directly, such as through models that waive cost-sharing for high-value services or focus on moderating drug prices, as well as indirectly, and through models that target low-value care and sources of waste that drive up patient costs and have proven challenging to confront in prior primary care-based models.  

Measuring Progress:

• Set targets to reduce the percentage of beneficiaries that forego care due to cost by 2030.
• All models will consider and include opportunities to improve affordability of high-value care for beneficiaries.

Aim: Align priorities and policies across CMS and aggressively engage payers, purchasers states, and beneficiaries to improve quality, to achieve optimal outcomes, to reduce health care costs. 

The CMS Innovation Center cannot achieve health transformation alone. It requires working across CMS and the entire federal government, as well as working hand-in-hand with health care teams and payers, purchasers, states, providers, patient advocates and patients. Success hinges on multi-payer alignment on clinical tools, outcome measures, payment, and policy approaches and building the capacity to transform health care. 

Measuring Progress:

• Where applicable, all new models will make multi-payer alignment available by 2030.
• All new models will collect and integrate patient perspectives across the life cycle.