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The American Journal of Accountable Care March 2019
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Safety Net Representation in Federal Payment and Care Delivery Reform Initiatives
J. Mac McCullough, PhD, MPH; Natasha Coult, MS; Michael Genau, MS; Ajay Raikhelkar, MS; Kailey Love, MBA, MS; and William Riley, PhD
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Safety Net Representation in Federal Payment and Care Delivery Reform Initiatives

J. Mac McCullough, PhD, MPH; Natasha Coult, MS; Michael Genau, MS; Ajay Raikhelkar, MS; Kailey Love, MBA, MS; and William Riley, PhD
Although safety net organizations are eligible for some two-thirds of federal payment reform programs, fewer than 20% of these programs directly target the safety net.
ABSTRACT

Objectives: Safety net organizations face challenges under new value-driven payment models. More than 70 payment reform programs were created through the CMS Center for Medicare and Medicaid Innovation (CMMI). These programs were analyzed to determine the extent to which they target safety net organizations.

Study Design: Systematic review of publicly available CMMI program descriptions.

Methods: We reviewed all CMMI programs’ stated goals, eligibility criteria, participating organizations (if applicable), and all other relevant information publicly available on the CMMI website. We classified each program as (1) specifically targeting the safety net, (2) applying to the safety net but not specifically targeting it, or (3) not applying to the safety net. For safety net initiatives, we also reviewed each program to determine which portion(s) of the safety net it was relevant to.

Results: Only 13 CMMI programs directly targeted safety net providers, 32 included safety net providers, and 22 programs did not apply to or target the safety net. No trends were found to suggest that this proportion was increasing over time. Safety net–relevant programs tended to target critical access hospitals rather than primary care or behavioral health.

Conclusions: Programs that specifically target the safety net may represent an important opportunity to overcome unique payment reform challenges facing this portion of the healthcare sector. However, safety net organizations are inconsistently represented in CMMI programs. There is currently no expedient approach to determine whether CMMI programs apply to specific safety net subsectors. Additional clarity regarding safety net relevance may help organizations understand and participate in relevant CMMI programs.

The American Journal of Accountable Care. 2019;7(1):17-23

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