The Affordable Care Act established the Center for Medicare & Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS) to find ways to reduce the cost of health care while improving its quality. CMMI is now developing and improving various value-based models, such as accountable care organizations, to test new ways for Medicare to pay for and deliver care. These models aim to reward value over volume and improve health outcomes for people with Medicare while reducing costs to the Medicare program.
A shift in payment design to reward value could help the program continue to provide high-quality care with fewer resources, but payment and delivery reforms will achieve their goals most effectively if people with Medicare are given the information they need and a voice in the process.
To help ensure that new models meet the needs of people with Medicare, the Medicare Rights Center joined with the AARP Public Policy Institute to identify a set of concrete consumer protections that should be integrated into the design of all Medicare-related value-based models.
This Research Report identifies and describes a checklist of seventeen consumer protections recommended for new Medicare payment and delivery models. Some recommendations are for actions CMMI or CMS could take; other recommendations are aimed at organizations and providers that are engaged in new Medicare models.