Expanding VBP: Fixing Design Flaws

The Centers for Medicare and Medicaid Services (CMS) has committed to having all Medicare beneficiaries in value-based payments (VBPs) by the end of this decade. Yet, today only about one third of traditional Medicare beneficiaries are in an accountable care organization (ACO). The uptake of VBP has been slow, slower than many people have expected. There are major challenges to expanding the proportion of Medicare patients in VBP arrangements to 100 percent. One set of challenges relate to the design of value-based programs. Another set relate to the implementation of value-based programs. Each will need to be addressed if CMS is to successfully realize its goal and, more importantly, re-shape payment to prioritize quality and lower cost over the provision of ever more services.