High-Value Comprehensive Care for Individuals, Families, and Communities: A Vision and Strategy for the Centers for Medicare and Medicaid Services In Collaboration with States, Payers, and Purchasers

The nation’s health care system has more capabilities than ever to improve health, but is falling short in terms of addressing longstanding challenges in quality, outcomes, and high and rising costs.  Closing these gaps requires intentional and accelerated steps to support more comprehensive and flexible models of care, in particular through alternative payment models (APMs) that bring greater transparency and accountability for results. A range of factors are converging to create urgency and opportunity to accelerate the shift toward comprehensive care models and APMs now.

Within this white paper, we propose a vision for high-value comprehensive care and a set of steps for achieving it.  Our vision builds upon previous efforts to define high-quality health care and describes an approach to care that is high-quality, holistic, reliable, and affordable to individuals and meets individuals’ needs and those of their families and communities. Our proposed pathway to this vision also builds on the experiences of the pandemic, lessons learned during the past decade of reforms, and recent interest in and movement toward value-based payment (VBP) models. These models can provide the accountability and redirection of resources needed to address many of the current system’s challenges, and findings from the past decade of VBP experimentation can provide guidance on which model approaches are most likely to yield significant improvements in health care delivery quality and outcomes. Within this white paper, we describe the following:

• the characteristics and goals of high-value comprehensive care;
• a pathway to achieving the delivery of high value comprehensive care through value-based payment; and
• key actions the Centers for Medicare and Medicaid Services can take to provide federal leadership in achieving the delivery of high-value comprehensive care; and
• key actions states, private payers, and purchasers can take to achieve and support the delivery of high-value comprehensive care.