What’s next for the CMS Innovation Center and Primary Care Payment Models?

We’re starting a new series of blog posts on important health care policy issues that are important for independent primary care physicians. We’re calling it “The Primary”, because we believe primary care should be the center of all health care policy, and we hope it will serve as a partner blog to our collection of stories from Elation primary care physicians, “The Practice”. Health care policy at the federal level affects everything primary care physicians do, and at Elation we want to help you navigate this changing and complex landscape. Please let us know if this is helpful to you, and please send us your feedback and questions at questions@elationhealth.com.

The Primary:

The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) develops and tests new health care payment and service delivery models to improve patient care and lower costs in Medicare and Medicaid/CHIP. CMMI is a powerful and flexible tool for payment innovation within HHS, and each government administration has left its mark on the Center. The Biden Administration recently announced that Elizabeth Fowler, PhD, will be the newest CMMI Director, a position that does not need Senate approval. 

Background:

CMMI was created as part of the Affordable Care Act 10 years ago to accelerate the shift to value-based care. Models typically run for 5 years, and test now payment and care delivery options to improve the quality of care or lower the cost of care, or both increase quality and lower cost at the same time. Most models are voluntary, but some have been mandatory, which has been very controversial with physicians and provider organizations. Models are evaluated yearly and at the end of the model lifecycle, and models that meet or exceed their goals may be “expanded” into the permanent Medicare or Medicaid/CHIP programs. CMMI receives $10B every 10 years, and those funds continue to be appropriated (made available to spend) by Congress on an ongoing basis. CMMI is required to report to Congress each year on its progress and outcomes (latest report made public – 2018). To date, CMMI has launched almost 50 new payment models, many of which focus on primary care as a key area for quality improvement and savings, including accountable care organizations (ACO) models, and models like Comprehensive Primary Care Plus. Results have been mixed, with moderate net savings to the Medicare program. Still, CMMI is an important tool for each administration to leave their mark, and potentially use to meet policy goals, as was evidenced in the Trump Administration.

What’s the Issue?

CMMI Director is an important administration role within HHS that will strongly influence the direction of value based care innovation over the next four years. Primary care physicians and practices are often at the center of payment models that seek to improve quality and reduce the cost of care, and many of these physicians are already in models like CPC+ and other ACO-style models. Before CMMI, Director Fowler was the Executive Vice President for Programs at the Commonwealth Fund, a prominent health care research firm. While at the Commonwealth Fund, she co-authored multiple reports and blog posts about value based care issues, including this post about the Direct Contracting “Geo” model option. Notably, a few short days after she took the helm at CMMI, it appears that the “Geo” model has been put under review and will not roll out as previously announced on January 15th. Additionally, Director Fowler was also previously a vice president for global health policy at Johnson & Johnson, and served in the Obama Administration during the implementation of the ACA. While the CMS Administrator nominee (Chiquita Brooks-LaSure) has not yet made it through Senate confirmation, it seems clear with Director Fowler’s appointment that the Biden Administration intends to use CMMI to further its health reform goals, and that these moves will directly affect primary care physicians and practices. 

What’s Next?

Over the coming months, as the Biden Administration’s HHS leadership are confirmed and begin work in their new roles, priorities for primary care-focused value based care innovation will be announced. Primary care physicians and practices can benefit greatly from participating in these programs, and more importantly, help shape the future of payment model innovation through participation and feedback provided to CMMI and CMS. Elation Health actively supports its physicians and practices who are participating in models like CPC+, and will continue to proactively seek out opportunities to advance value based care through its platform and approach. We’ll also keep you informed about other opportunities and changes as they happen. 

Read More:

Systematic review of CMMI Primary Care Initiatives (2018)

National Law Review – Evaluation of Innovation Center Models (2021)

CMS Innovation Center at 10 Years – Progress and Lessons Learned (2021)