A Path Forward for Multipayer Alignment to Achieve Comprehensive, Equitable, and Affordable Care

KEY TAKEAWAYS

• Improving multipayer alignment across key features of value-based payment models is widely recognized as critical for reducing administrative burden and achieving common goals, such as improving population health and affordability. The Center for Medicare and Medicaid Services (CMS) has made multipayer alignment a strategic pillar, and it is a growing part of state and employer efforts.
• However, differences in priorities, capabilities, and contracting processes have limited progress on
• comprehensive multipayer alignment around quality measures and other key payment reform elements and supports. At the same time, high-level conceptual alignment approaches that recognize these differences and allow for flexibility have often lacked clear and measurable steps to accelerate and sustain progress across these approaches.
• Informed by a series of stakeholder workshops and an evidence review, we propose a pragmatic, iterative multipayer alignment framework to achieve increasingly substantial alignment, with three components:
  • Identifying and leveraging shared goals that motivate shared, ongoing action for alignment;
  • Creating an alignment pathway to help achieve these shared goals through short-term actionable steps on five foundational elements of alignment: performance measurement and reporting, measures and initiatives related to health equity, other key payment model components (such as attribution, benchmarking and risk adjustment), timely and consistent data sharing, and technical assistance; and
  • Reimagining how CMS, with current resources and authorities, can facilitate more meaningful Medicare participation in multipayer initiatives and provide other supports for state and employer alignment efforts nationwide.
• This framework can help states and regions to establish and implement multipayer initiatives, make meaningful and measurable progress in these initiatives, align more effectively with Medicare reforms, and build out the critical mass necessary to achieve value-based care transformation.