Maintain and improve Medicare Innovation
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As Congress and the new administration prepare to embark on significant changes to federal healthcare policy, we should not lose sight of an important goal: making Medicare and Medicaid, which serve the health needs of tens of millions of Americans, more value-driven by enhancing patient quality and controlling costs. In addressing this goal, policymakers would do well to maintain the agency charged with testing new healthcare delivery and payment innovations, while instituting improvements that ensure beneficiary safety.

In making changes to the Affordable Care Act, there are compelling reasons to maintain the Center for Medicare and Medicaid Innovation (CMMI). Since its inception, CMMI has launched more than 40 demonstration projects involving hospitals, physicians, patients, and other health sectors. In many of its early efforts, CMMI engaged collaboratively with these stakeholders in testing quality improvement and payment reform efforts on a small scale. We were excited by the power and potential the agency held for leading collaborative innovation in our nation’s healthcare system. 

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Unfortunately, CMMI recently moved well beyond its congressional mandate and vastly increased the scope of its experimentation. The results were national, mandatory demonstrations rather than targeted, voluntary pilots designed to be nimble and collect valuable learnings.

At the same time, and just as disconcerting, CMMI became less inclusive and transparent. For example, the controversial Medicare Part B drug reimbursement experiment proposed earlier this year involved no stakeholder input and was not only national in scope but also mandatory. For many physicians, this presented a dangerous experiment on patient care and threatened patients’ access to vital treatment options.

In other instances, CMMI has moved far too quickly to implement new delivery and payment models without adequately engaging stakeholders and before fully measuring, analyzing, and sharing lessons learned from the pilot stage. For providers, this means keeping up with new pilot tests while still implementing other federally-mandated reforms in parallel, creating significant expense and disruption. It is distressing that millions of patients relying on Medicare and Medicaid are unknowing participants in experiments that can dramatically affect their care and in which they have little opportunity for input or consent.

To be clear, we believe in the concept of a CMMI. Our nation needs the brightest minds in healthcare focused on innovation and value-based care that improves healthcare quality and manages costs. However, there needs to be clear agreement on the CMMI charter and the manner in which it operates. For the agency to function as originally intended, several important ground rules must be implemented: 

  • The scope and scale of CMMI projects must be reduced such that statistically-significant data can be collected but without affecting unduly large numbers of patients and providers, especially in early pilot stages.
  • Pilot projects must be voluntary and nimble, with full disclosure to patients regarding participation and without undue bureaucracy and burden on providers to implement.
  • Greater transparency and meaningful stakeholder engagement must be ensured. Data from projects must be immediately and publicly accessible.
  • Effective quality and patient safety measurements must be put in place to monitor the results of new models – and respond quickly should problems arise.
  • Congress must be able to monitor CMMI progress and maintain its appropriate role in shaping Medicare policy, but without hamstringing the CMMI charter.

There is clear need for continual improvements in healthcare delivery and payment reform for Medicare and Medicaid and the patients they serve. A center that tests new innovative ideas that may blossom into value-enhancing policy continues to be a good idea, but the appropriate protections must be in place to ensure no harm is done to those involved.

Mary Grealy is the President of the Healthcare Leadership Council. Ted Okon is the Executive Director of the Community Oncology Alliance.


The views expressed by authors are their own and not the views of The Hill.