With so much in a state of flux in Washington, D.C. these days when it comes to federal healthcare policy, policy and advocacy leaders across U.S. healthcare have been particularly anxious to get a sense of where the Center for Medicare and Medicaid Innovation (CMMI), also referred to as the CMS Innovation Center, might be headed. CMMI is a center for payment innovation within the federal Centers for Medicare and Medicaid Services (CMS). As described on its website, “The Innovation Center allows the Medicare and Medicaid programs to test models that improve care, lower costs, and better align payment systems to support patient-centered practices. The Innovation Center carefully evaluates innovative reform efforts widely used in the private sector, and is unique in its ability to develop provider-proposed approaches and quickly adjust models in response to feedback from clinicians and patients.”
Further, as the website description for CMMI notes, “The Innovation Center was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). Congress created the Innovation Center for the purpose of testing “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. Congress provided the Secretary of Health and Human Services (HHS) with the authority to expand the scope and duration of a model being tested through rulemaking, including the option of testing on a nationwide basis.”
At the dawn of the Trump administration, there was considerable concern that CMMI might be shut down entirely; that concern was partly based on statements that Tom Price, M.D. had made when he was a Republican congressman, prior to his appointment as Secretary of Health and Human Services. With the failure of attempts to repeal and replace the ACA this year, and then with Price’s resignation as HHS Secretary, the landscape appears to have changed somewhat.
And while some in the healthcare industry might think that some of the developments around the ongoing dynamics around the CMMI might be perceived as “inside baseball,” some mainstream media are picking up on the significance of the “CMMI question.” For example, in a September 21 report in POLITICO’s “Morning eHealth” section online, Darius Tahir wrote, under the headline, “CMMI DRAMA HITS OPERATIC LEVEL,” “As we teased in Wednesday’s Morning eHealth, CMS’s request for information on CMMI has landed. That’s the controversial office chartered by the Affordable Care Act with sweeping powers to reshape Medicare. The broad brushes are vague, but intriguing, and have piqued the interest of all the players in this drama. Let’s start by reviewing the RFI,” he wrote, linking to the RFI document. “Outlined in broad strokes is the new direction CMS intends to set for the Innovation Center, but the document also emphasizes that CMS wants to hear from you. Of particular interest to eHealth: the center wants to facilitate more advanced payment models; to empower consumer choice (potentially by “facilitat[ing] and encourag[ing] price and quality transparency”); to explore value-based pay models for drugs; to pay for behavioral health in novel ways (potentially by focusing on integrating care); and program integrity (i.e. fighting fraud). The office specifically asks for technologists’ input in the area of consumer choice.”
In fact, Tahir wrote on Sep. 21, “The mere announcement touched off controversy,” noting the fact that
“Former CMS staffer Aisling McDonough argued on Twitter that CMS’s method of soliciting comments was a blow against government transparency. The agency directed readers to submit their thoughts via an informal survey (here), and advised respondents that the agency may or may not publicly post the comments. The information gleaned through this process may be used by the government, the text of the survey further advises. Typically,” Tahir explained, “when the government engages in these sorts of administrative processes, they post the comments online — which is a good way to track what different organizations publicly think about policy. Depending on CMS’s approach to the information it gathers, outside observers will lose a tool to track the government’s policy process.”
Meanwhile, just two days earlier, on Sep. 19, CMS Administrator Seema Verma had published an op-ed in the Wall Street Journal, in which she stated that CMMI is interested in testing models in eight focus areas including increased participation in advanced alternative payment models, consumer-directed care and market-based innovation, physician specialty models, prescription drug models, Medicare Advantage innovation models, state-based and local innovation, including Medicaid focused models, mental and behavioral health models and program integrity. “Providers need the freedom to design and offer new approaches to delivering care,” Verma wrote. “Our goal is to increase flexibility by providing more waivers from current requirements.” Further, she said, CMS wants to see more competition between providers to compete for patients in a free market system. Transparency is needed for consumers to be more cost-conscious, she emphasized. “We will move away from the assumption that Washington can engineer a more efficient healthcare system from afar -- that we should specify the processes healthcare providers are required to follow,” Verma added.
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