The Center for Medicare and Medicaid Innovation (CMMI), a think-tank-cum-test bed for new payment models, is getting an overhaul in how it approaches healthcare innovation and payment reform. The Center for Medicare & Medicaid Services (CMS) plans to back down from the mandate-driven structure of its pilot programs and encourage more input and competition from free enterprise.
“This administration plans to lead the Innovation Center in a new direction,” CMS Administrator Seema Verma announced in an op-ed published in The Wall Street Journal. “Providers need the freedom to design and offer new approaches to delivering care. Our goal is to increase flexibility by providing more waivers from current requirements.” The new vision for CMMI is to transfer it to a consumer-based operation, allowing the market to drive the innovation.
The changes at CMMI weren’t entirely unexpected. The center has a much-hated parent, at least for Republicans: It was created and funded by provisions in the Affordable Care Act. U.S. Health and Human Services Secretary Tom Price expressed his wish to overhaul the center in early 2017, before he was appointed to the top health position. "CMMI … has gotten off track a bit and has been mandatorily dictating to physicians how they must practice," Price said during his January confirmation hearing in front of the Senate Finance Committee. "We can move CMMI in a direction that actually makes sense for patients."
More significant for providers, CMMI was the spawning pool for most of the new payment models and bundled-payment pilots that have been introduced since 2014. Few, if any, of the projects have been hailed as amazing successes. The various accountable care organization (ACO) models sounded great on paper but suffered in multifront battles with provider buyin and data exchange technology. Myriad waivers and graduated compliance timetables were cumbersome and confusing.
Bundled-payment pilots, scaled to focus on a specific, expensive procedure such as a joint replacement or a heart bypass, have fared slightly better but haven’t quite earned large fan clubs. As of September 2017, approximately 1,200 participants have signed up for either bundled payment Model 2 or Model 3, the two models that include post-acute care. No matter how the pilots are structured, there never seems to be enough room for customization to match the unique attributes of the participant’s care delivery setting.
Meanwhile, the cost savings for CMS hasn’t really shown itself, and providers are tired of being told how to run their practices. “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 said in her op-ed. Yet, it seems to be a 180-degree turn from the previous mission, which touted value-based care over fee scheduling.
As Verma prepares the healthcare industry for changes in how the payment pilots are being run, I’m sure it won’t be the last time we heard about operational and mission changes at CMMI. Much of what is taking place reflects a key characteristic of the Trump Administration: Remove the shackles of government mandates and the market competition will steer the ship.
I hope they’re right. Hitting all those rocks out in the swirling healthcare harbor could require a hip replacement, after all.