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CMS looking to get more ACA plans into value-based care arrangements 

  • CMS officials are pushing to align quality standards across government programs to spur greater investment in value-based care.  
  • This quality metrics alignment across the center’s various programs intends to orient providers on where to focus their efforts.  
  • An MGMA report stated that value-based contracts average about $30,922 in revenue per provider.  

The U.S. Centers for Medicare and Medicaid Services (CMS) are looking at quality metrics to get Affordable Care Act (ACA) exchange plans into value-based care. CMS officials are pushing to align quality standards across government programs to spur greater investment in value-based care.  

At the Health Care Payment Learning and Action Network Summit, CMS officials said a lot of effort on the ACA’s insurance marketplaces has focused on enrollment and expanding coverage. On this, the CMS is hoping to send a stronger signal to get value-based care plans involved. 

Quality metrics and rating system  

According to the Director of CMSs Center for Consumer Information and Insurance Oversight, Ellen Montz, the institution has had many discussions about value-based plans. Montz also stated that the CMS has a foundational tool for paying for value, referring to the quality metrics and rating system.  

The CMS is trying to align quality metrics across the center’s various programs to orient providers where to focus their efforts. This effort to align quality standards can also help reduce the administrative burden and provider burnout.  

A recent MGMA report provided key benchmarks for quality measures. Median quality measure performance across all reporting practices were:   

  • 3% hospital admission rate.  
  • 11% hospital 30-day readmission rate.  
  • 27% emergency department utilization rate.  
  • 1% 30-day postoperative infection rate. 

From fee-for-service to value-based care  

Improving patient access and care delivery are leading priorities for healthcare leaders. The MGMA report also noted that the gradual move away from fee-for-service will continue. 

Regarding value-based, the MGMA stated that these contracts accounted for 7% of medical revenue among primary care specialties, 6% among surgical specialties, and 15% among nonsurgical specialties. On average, that represents about $30,922 in revenue per provider.  

Stay tuned for this and more industry news through our December 2022 newsletter. Subscribe to our monthly newsletter and our Health Prime blog for ongoing leading industry medical practice articles and policy updates.  



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