CMS Innovation Center Seeks New Direction to Encourage Competition, Flexibility

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CMS has issued an informal request for information seeking input on a new direction promoting patient-centered care and market-driven reforms for the CMS Innovation Center.

CMS has issued an informal request for information seeking input on a new direction promoting patient-centered care and market-driven reforms for the CMS Innovation Center.

In an op-ed published in The Wall Street Journal, CMS Administrator Seema Verma noted the large numbers of Americans enrolled in Medicare and Medicaid plus the fiscal concerns surrounding those problems as a reason for leading the Innovation Center in a new direction.

“We will move away from the assumption that Washington can engineer a more efficient health-care system from afar—that we should specify the processes health-care providers are required to follow,” Verma wrote.

She added that CMS was analyzing current Innovation Center models to determine which ones should continue and which ones should not. In its request for information, CMS noted the following guiding principles:

  • Promote competition based on quality, outcomes, and costs.
  • Focus on voluntary models; reduce burdensome requirements and unnecessary regulations to allow physicians and other providers to focus on providing high-quality healthcare; and give patients and providers tools to make informed decisions.
  • Empower patients, their families, and caregivers to take ownership of their health and provide them with information and flexibility to make choices.
  • Use data-driven insights to ensure cost-effective care that also improves outcomes.
  • Draw on partnerships and collaborations for a transparent model design and evaluation.
  • Test smaller scale models that can be scaled up if they meet requirements for expansion under the Affordable Care Act.

1. Advanced alternative payment models (APMs)

Under the Medicare Access and CHIP Reauthorization Act, clinicians can choose to participate in an Advanced APM. The innovation Center is seeking ways to increase opportunities for eligible clinicians to participate in Advanced APMs.

2. Consumer-directed care and market-based innovation models

Beneficiaries should be empowered as consumers to make choices among competitors in a market-driven healthcare system. CMS is considering new options to promote consumerism and transparency.

3. Physician specialty models

CMS wants to increase specialty physician models to improve quality of care and lower costs by engaging specialty physicians in APMs.

4. Prescription drug models

CMS wants to test new prescription drug payment models in Medicare Part B and Part D and state Medicaid programs. Models should engage beneficiaries as consumers and promote novel arrangements between plans, manufacturers, and stakeholders.

5. Medicare Advantage innovation models

The Medicare Advantage Value-Based Insurance Design model is one example of providing more flexibility to improve outcomes, but CMS believes this model can be modified to provide more flexibility. The agency seeks other demonstrations that incentivize plans to compete for beneficiaries.

6. State-based and local innovation

CMS wants to increase partnership with states on additional state-led models that drive reform and innovation. Models would vary based on the needs and goals of each state.

7. Mental and behavioral health models

CMS is looking for models to improve care for behavioral health, including a focus on opioids, substance use disorder, and dementia, as well as improve participation of mental health care providers in Medicare, Medicaid, and the Children’s Health Insurance Plan.

8. Program integrity

The agency is seeking ways to reduce fraud, waste, and abuse, as well as improve program integrity.

There will also be main 8 areas where the Innovation Center is interested in testing models:

“There are a lot of great ideas, and we want to hear from people on the front lines,” Verma wrote. “No government agency has all of the answers, especially in an industry as large and multifaceted as healthcare.”

The announcement of the new direction of the Innovation Center comes just days after Patrick Conway, MD, MSc, left his position in CMS as head of the Innovation Center to serve as president and CEO of Blue Cross Blue Shield of North Carolina.

The comment period will remain open through November 20, 2017, and ways to submit comments can be found here.