FEATURE · ALTERNATIVE PAYMENT MODELS Brooks-LaSure and Fowler Make It Clear:
There’s a New APM Sheriff’s Posse in Town In a groundbreaking article in the Health Affairs Blog, CMS Administrator Chiquita Brooks-LaSure and CMMI Director Elizabeth Fowler make it clear that they’re about to rearrange the APM landscape for providers By Mark Hagland
M
any healthcare policy observers found their heads and necks expe- riencing some form of whiplash
under the previous administration, as they found the messages coming out of the Centers for Medicare & Medicaid Services (CMS), and particularly, the pronounce- ments coming from Seema Verma, to be confusing and sometimes contradictory. On the one hand, then-Administrator Verma spent a great deal of time and energy push- ing the Trump administration line (which over time literally became template lan- guage inserted in nearly every CMS press release) that the way forward must inevi- tably involve unleashing consumer choice and the “power of the free market,” even as Verma regularly castigated the leaders of accountable care organizations (ACOs) for not moving quickly into two-sided risk. Verma seemed to be completely unaware of any contradiction between on the one
give them adequate time to decide how to move forward into risk, or even enough time to sort through their data to figure out whether they could succeed in two- sided risk, or even continue to participate in the MSSP. There was also a fair amount of turnover at the Center for Medicare & Medicaid Innovation (CMMI), under Verma. Adam Boehler, who came to CMMI in April 2018 after a stint at Landmark Health, received praise for setting out some good ideas, but he was gone by September 2019, when Donald Trump appointed him to be CEO of the then-newly-formed U.S. International Development Finance Corporation. That’s not to say that there was a com- plete lack of policy coherence at CMMI under Verma; indeed, on June 3 of last year, she wrote in a Health Affairs Blog article that “flexibilities” and “sufficient financial incentives that encourage higher-quality
Ph.D., J.D., the new CMMI Director,
spoke to leaders of NAACOS, the National Association of ACOs, on April 20. As Senior Contributing Editor David Raths wrote on that date, “In an April 20 talk to the National Association of ACOs, Elizabeth Fowler, J.D., Ph.D., the recently named director of the Center for Medicare and Medicaid Innovation (CMMI), said the organization is at a “crossroads,” and is undergoing a strategic evaluation to deter- mine how its alternative payment models can have a transformative impact on the healthcare delivery system. She added that CMMI will be looking at models with a health equity lens. Fowler began her talk by noting that the pandemic has shown us how far we have to go by revealing some of our biggest shortcomings,” and then “turned to some lessons learned from the 10 years of CMMI’s existence. Fowler noted that health system transfor- mation is not easy and it is an iterative process. ‘Ultimately, at CMMI we want our alternative care models to position participants for success,’ she said, adding that sometimes that means speeding up when there’s an opportunity, and some- times it means taking a break to ensure that a forthcoming model can realistically deliver on what’s intended and that it’s the strongest option based on evidence and data.” Indeed, in the weeks before that address, CMMI had put several models on hold for additional review, includ- ing Primary Care First and Geographic Direct Contracting models. Others have been delayed, including the Kidney Care Choices and the Chart ACO track.
Photo © Danny Raustadt |
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hand insisting that the market would take care of everything (once healthcare consumers were fully empowered with data and information), and on the other hand, stating quite vehemently that pro- vider leaders needed to move tout de suite into two-sided risk under the Medicare Shared Savings Program (MSSP), and, as some provider leaders insisted, failing to
outcomes,” must be foundational to any new alternative payment models (APMs) created. It’s hard to know exactly in which direction CMMI might have evolved, had the Trump administration continued; but it did not.
Meanwhile, hints about new directions under the Biden administration came as early as April, when Elizabeth Fowler,
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hcinnovationgroup.com | SEPTEMBER/OCTOBER 2021
A new central organizing principle for APMs: health equity And then, Brooks-LaSure, Fowler, and two other senior healthcare policy officials— Meena Sheshamani, M.D., Ph.D., Deputy Administrator & Director at CMMI, and Daniel Tsai, Deputy Administrator & Director, Center for Medicaid & CHIP Services, at CMS—made their intentions clear in a Health Affairs Blog article pub- lished online on August 12. In the article, entitled “Innovation At The Centers for
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