Liz Fowler, the director of the Center for Medicare and Medicaid Innovation (CMMI) recently spoke at the National Association of ACO’s spring conference of the future of value-based care payment models, noting that “our commitment to value-based care has never been stronger,” but also acknowledging that “we need to be honest about the nature of innovation, that not everything is going to be a home run.”
Fowler’s comments at the event followed CMMI’s decision to pause the Geographic Direct Contracting Model that tied value-based care capitated payments to providers based on regional health outcomes. CMMI also paused the Primary Care First Seriously Ill Population Model and delayed the start dates for a few other models, including the Kidney Care Choices model.
Fowler acknowledged that “collectively, these announcements may have raised questions about where [CMMI] is headed next,” and noting that “true innovation means failing until we get things right.”
Fowler noted that the landscape of value-based care models has gotten complex with overlapping and providers having to compete over benchmarks and savings, which has had an impact on evaluating the effectiveness of the models. She also discussed the recommendations by the Medicare Payment Advisory Commission (MedPAC) that CMMI develop fewer, more strategic/innovative models to lessen the overlap, saying that such a change is “easier said than done.”
Fowler also discussed that much of the work done by CMMI has been aimed at certifying a model to ensure it is a permanent part of Medicare, which means that a model has to be designated in a certain way and “can be very limiting.” Only four models have so far become a permanent part of Medicare. Fowler instead suggested perhaps thinking “about the overall goal being transformation of the system instead of certification or both.”
During her presentation, she also covered some of her own priorities for CMMI and how she hopes to rethink the development and evaluation of models, starting with considering health equity at every stage in the models. Such a consideration may include requirements for all new models to collect and report data on race and ethnicity, or developing and testing models that directly reduce healthcare disparities. Fowler also mentioned another priority, which is to expand the reach of CMMI past just Medicare and begin to look at Medicaid and engage with more payers to do a better job with multi-payer alignment.
Fowler concluded by emphasizing that while some models may be reviewed or delayed and it may look as though CMMI is “pulling back sometimes,” that is not the case. For her part, Ms. Fowler has a background in health policy and previously held leadership roles within the Department of Health and Human Services and was a senate staffer who helped to draft and implement the Affordable Care Act.