Two months ago, Centers for Medicare & Medicaid Services Administrator Seema Verma announced that the Trump Administration plans to lead the Center for Medicare and Medicaid Innovation (CMMI) “in a new direction” to give providers more flexibility with new payment models and to increase healthcare competition.
Congress created the Center for Medicare and Medicaid Innovation (CMMI) in 2010 to test new approaches and models to pay for and deliver health care. In the op-ed, titled “Medicare and Medicaid Need Innovation,” Verma, who is an appointee of President Donald Trump, referred to CMMI as a “powerful tool” for CMS to improve quality and reduce costs.
In an op-ed in the Wall Street Journal, Verma announced that CMS was issuing a “request for information” to collect ideas on the path forward. “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 provider are required to follow,” Verma wrote.
Responses to CMS's RFI on the Innovation Center New Direction were due Monday, and several health IT and healthcare industry organizations submitted feedback on the future of CMMI.
As previously reported by Healthcare Informatics Managing Editor Rajiv Leventhal, Charlotte-based Premier said the center should take to “promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.”
In its comments, Premier officials highlighted how critical it is for CMMI to continue to serve as a leader in testing value-based care models, incorporating the successes of past models into new models.
In its comments, the EHR Association recommended that CMS harmonize the technology requirements of new payment models with the requirements related to certified EHR technology (CEHRT) already incorporated into other programs, such as advanced alternative payment models (APMs) and the Merit-Based Incentive Payment System (MIPS). “If additional technology capabilities are needed for a program, aligning those technical needs with criteria included in CEHRT, as opposed to defining ad hoc prescriptive functional requirements, will help reduce vendor burden in developing new features and implementing them in customer systems,” the EHR Association wrote in its letter
The organization also wrote, “As CMS moves in a new direction that promotes patient-centered care and tests market-driven reforms that empower beneficiaries as consumers, provide price transparency, and increase choices and competitor to drive quality, reduce costs, and improve outcomes, EHRA anticipates that technology and information systems will continue to play a pivotal role in the success of these models. In preparation for these changes and throughout the development of new models, the Association encourages CMS to collaboratively engage with health IT developers to ensure that the technology we are delivering to providers aligns with the needs of the models.”
The American Medical Informatics Association (AMIA) also offered several suggestions on how the CMS Innovation Center should approach future payment and delivery models, supported by health IT and health informatics. In comments it submitted in response to the RFI, AMIA recommended that CMS look for ways to provide “innovation support” to grantees, while also leveraging new models and pilots to further promote and optimize the use of informatics tools and capabilities for improved patient care.
AMIA strongly encouraged the Innovation Center to “consider ways it can provide innovation support, not simply financial support, to transform care delivery.” AMIA also suggested that the Innovation Center provide direct funding and implement enhanced application requirements that further promote and optimize the use of informatics tools and capabilities in these models. “Just as clinicians are expected to use medical devices and pharmaceuticals to improve patient outcomes,” AMIA argued, “so too must we expect them to leverage evidence-based informatics tools and methodologies.”
“Future success will be dependent on how well we collect, analyze, and apply data to patient care,” Douglas B. Fridsma, M.D., Ph.D., AMIA president and CEO, said in a statement. “As the Innovation Center considers its future role, it’s imperative that it considers ways to improve and optimize the use of informatics for patient care and clinician satisfaction. By leveraging its funding streams and application requirements to improve informatics tools and methodologies, the Innovation Center could be well-positioned to have a lasting positive impact on the U.S. healthcare system.”
The American Hospital Association made a number of recommendations to CMS in its comment letter, specifically mentioning the timely availability of data. “Model participants should have readily available, timely access to data about their patient populations. CMMI should actively explore and dedicate resources to determining methods that would provide participants with more complete, timely, perhaps real-time data,” the AHA wrote.
In addition to the comments submitted to CMS in response to the RFI, leaders of the Health Care Transformation Task Force shared their thoughts on a new direction for CMMI in a Health Affairs blog. In the blog post, Jeff Micklos, executive director of the Health Care Transformation Task Force, and Clare Wrobel, director of payment reform models for the Health Care Transformation Task Force, wrote that while new ideas on innovation are welcome, yet CMS leaders should not discard existing models showing promise.
“We believe that a new direction need not mean discarding all current models. Given the level of stakeholder investment and the growing evidence base to support several models (e.g., accountable care and bundled payment programs), CMMI should focus on making improvements to these promising models as part of its refined agenda,” the leaders of the Health Care Transformation Task Force wrote.