CMS plans ‘new direction’ for CMMI models

CMS Administrator Seema Verma, MPH, said the Trump administration will take the Center for Medicare and Medicaid Innovation (CMMI) in a “new direction,” claiming the policies under the last administration encouraged consolidation and providers need more “freedom” to design new care delivery models.

Verma announced the change in a Sept. 19 op-ed in the Wall Street Journal, which precipitated a request for information (RFI) from healthcare organizations on what form new CMMI models should take in areas like Advanced Alternative Payment Models (AAPMs), Medicare Advantage and prescription drugs.

“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.

The request falls in line with the positions Verma and HHS Secretary Tom Price, MD, have taken both before and during their tenure in the administration. Price in particular was critical of mandatory CMMI models, leading to CMS canceling two mandatory bundled payment programs which were set to begin in 2018.

The new direction, according to Verma, will remain focused on transitioning away from fee-for-service and hold providers accountable for outcomes. But efforts under Verma and Price will be geared towards “choice and competition” using smaller scale, voluntary models along with price and quality transparency efforts to better inform patients about their care choices.

“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,” Verma wrote. “Consumers are a critical part of the health-care equation. We need to empower patients with information to seek value and quality as they shop for services. They also need incentives to be cost-conscious. Patients can define value better than the federal government can.”

The RFI specifically mentioned increasing specialty physician participation in alternative payment models. One possibility it floated was to “include specialty physician management of a defined population of beneficiaries with complex or chronic medical conditions,” possibly with the specialist serving as the beneficiary primary source of care.

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