Opinion

CMMI’s Future: The Overlooked Issue in Price’s Confirmation Hearings

The news coverage of new Health and Human Services Secretary Tom Price’s Senate confirmation largely focused on personal financial matters and the Trump administration’s plans for replacing the Affordable Care Act. Unfortunately, the media coverage largely overlooked a highly significant statement by the secretary that has great ramifications for the future of the Medicare program and, more broadly, the long-term sustainability of our health care system. 

When asked in the Senate Finance Committee hearing about the Center for Medicare and Medicaid Innovation, now-Secretary Price said, “We can move CMMI in a direction that actually makes sense for patients.” This was an encouraging statement for those of us who believe in the necessity of a framework with which to test creative new ideas for making Medicare more quality-driven, patient-centered and cost-effective at the same time.

CMMI was created as part of the ACA and has earned its share of controversy, most notably for a proposed demonstration project of near-national scope that might have threatened cancer patients’ access to critical medications. In fact, there has been a considerable amount of conjecture that Congress might move to do away with the Center.

That would be a mistake, though. We know that Medicare cannot remain in its current state. The direction, and a correct one, in health care today is to transition from traditional fee-for-service medicine to a value-based orientation that achieves improved quality and better patient outcomes at reduced costs. CMMI is a valuable platform in testing new concepts in health care payment and delivery to determine what has the potential to achieve these objectives on a system-wide basis.

Price is right in his statement about moving CMMI in an improved direction. In some critical respects, the Center has strayed from its intended mission. Demonstration projects should not be taking place over nearly the entire nation, but rather in limited geographic areas that yield statistically-meaningful data. 

Further, transparency in both data sharing and decision-making has to improve. Certainly, patients should be made aware if their physician or hospital is entering a new demonstration project that could affect their care. And there needs to be greater collaboration between CMMI and the various health care stakeholders that are going to be involved in testing innovative concepts to ensure that there will not be any adverse, unintended consequences. Effects on quality must be measured, because CMMI will be a success if patients experience better outcomes for the money spent on their care.

Secretary Price told senators at his confirmation hearings that he believes strongly in innovation. That’s good news for a health care system that is still forging a pathway toward a value-driven future. We’re pleased that he is not proposing an end to the current platform for developing better mechanisms for delivering and paying for care, but rather fixing its flaws. A CMMI 2.0 that engages in limited-scope testing of new ideas, complete and consistent transparency, and robust public-private collaboration with the entities throughout the health care system that are perpetually developing innovative approaches to care will be a tremendous asset to the American public and to our current and future patient populations.

This future of CMMI may not have generated headlines coming out of the coverage of Secretary Price’s confirmation, but it will have a difference-making impact on the quality and affordability of American health care.

 

Mary R. Grealy is president of the Healthcare Leadership Council. Mark R. Chassin, M.D., is president and CEO of the Joint Commission.

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