Conway: Medicare Payment Has Changed Tremendously in Just a Few Years

With 6 years under his belt, Patrick Conway, MD, is the longest serving chief medical officer in CMS history. During those 6 years, he has seen alignment with private payers increasing, Conway said during a plenary session at the fall meeting of the National Association of Accountable Care Organizations.

He opened his talk with a story about his mother, who is now being cared for by an accountable care organization (ACO). When she first received the letter that her doctor was in an ACO and she could opt out, she considered it, but Conway encouraged her to stay in. Now, she reports feeling like her doctor is more available and that the practice does a better job of keeping in touch with her and making sure she’s on her medications and taking them as needed.

“What we want for our health system—for us and for our family members—is a health system that supports us when and where and how we want it to, to keep us as healthy as possible,” Conway said. “I do think we’re in an evolving state. A lot of this is just removing barriers.”

Part of the plan to get to that health system was the goals that CMS set to reach 30% of alternative payment models and 85% in some value-based arrangement by the end of 2016. CMS reached both goals nearly a full year early.

Conway discussed the Health Care Payment Learning and Action Network, which brings together private payers, HHS, providers, employers, and other stakeholders. It will start reporting on how different payers are paying for care based on claims. The plan is that it will become a frequent and common reporting mechanism. Participating groups are agreeing on the quality measures that should be reported, which has led to increased alignment.

“It is very common now that a private payer will say, ‘Show me your [Medicare Shared Savings Program] track 3 contract; I’ll take it,’” Conway said. And this sort of work will lead to more healthcare transformation and greater improvement across the system.

As for the Medicare ACO program, there are changes being considered. According to Conway, CMS is looking to evolve the program by considering how to implement a revenue-based standard with a level of risk that is lower than the level of risk currently in tracks 2 and 3. This would allow ACOs in track 1 to move up to some risk.

Echoing what Sean Cavanaugh, deputy administration and director of the Center for Medicare at CMS, said earlier in the day, Conway said that the ACO program is doing better than some people give it credit for.

He called the results of the program “better than expected” and added that there are people who have been in the program for just 2 years, and the amount of transformation that has taken place has been incredible.

“Transformation takes time,” Conway said. “It’s a long journey; it’s not a sprint.”