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POLICY PERSPECTIVE · APMs


CMS’s Strategic Plan for CMMI: A New Administration Shifts


on Policy—and Strategy Will CMMI fare better now under new management, under the new administration? The issues facing Chiquita Brooks-LaSure and Liz Fowler are complex, but at least they’ve got a strategy by Mark Hagland


A


s we reported earlier, “On Wednesday, Oct. 20, top officials at the Centers for Medicare and Medicaid Services (CMS) and innovation arm, the Center for Medicare and Medicaid Innovation (CMMI) held a webinar for members of the news media, in order to outline their strategy for CMMI going forward. CMS Administrator Chiquita Brooks-LaSure and CMMI Director Elizabeth (Liz) Fowler, Ph.D., J.D., made extensive comments, and were supported by other CMS and CMMI officials, who explained their strategy, in a webinar whose name matched that of the white paper they released at the same moment: ‘Driving Health System Transformation: A Strategy for the CMS Innovation Center’s Second Decade.’” As we reported, “As all the officials speaking during the one-hour webinar emphasized, CMMI’s strategy going for- ward will be to help to shift the current U.S. healthcare system toward becoming “a health system that achieves equitable outcomes through high-quality, afford- able, person-centered care.” In fact, “Administrator Brooks-LaSure told the remotely connected audience that she is absolutely committed to the goal ‘that CMS serve the public as a trusted partner and steward, dedicated to expanding health equity… and improving health outcomes. To me, everything we do at CMS should be aligned with one or more of our six strategic pillars,’ she emphasized.” The white paper that the CMS officials discussed at length, entitled “Driving Health


Medicaid Innovation (CMS Innovation Center or “Innovation Center”) is launching a bold new strategy with the goal of achieving equitable outcomes through high-quality, affordable, person- centered care. To achieve this vision, the Innovation Center is launching a strategic refresh organized around five objectives. These strategic objectives will guide the Innovation Center’s models and priori- ties, and progress on achieving goals for each will be to assess the CMS Innovation Center’s work and impact.”


System Transformation—A Strategy for the CMS Innovation Center’s Second Decade,” outlines a very major set of policy changes for CMMI, as the flag- ship innovation agency inside CMS. Its introduction opens with this set of state- ments: “The Center for Medicare and


The white paper stated that “The last ten years of testing and learning have laid a strong foundation for the CMS Innovation Center to lead the way towards broad and equitable health system transformation. This white paper describes the Innovation Center’s refreshed vision and strategy and provides examples of approaches and efforts under consideration to achieve the goals of each strategic objective. The Innovation Center’s overarching goal will continue to be expansion of success- ful models that reduce program costs and improve quality and outcomes for Medicare and Medicaid beneficiaries. In addition, the paper emphasizes how measuring progress toward broader health system transformation is also critical to achieving these goals and vision.” And Administrator Brooks-LaSure emphasized in her comments on Wednesday, that the following will be the most important priorities for CMMI going forward: improving health equity by addressing systemic health disparities; “work[ing] to integrate the perspectives of CMS stakeholders into our policy and program development”; building on the Affordable Care Act (ACA) to expand access to quality, affordable” healthcare, in the context of the Biden administration’s “Build Back Better” strategy; “protecting


26 hcinnovationgroup.com | NOVEMBER/DECEMBER 2021


our programs’ sustainability into the future by serving as a responsible steward of pub- lic funds”; “driving innovation to tackle our other system challenges and promote value-based, person-centered care”; and promoting innovation not only in the healthcare system, but also inside CMS itself as a employer.


So, how big a change is this? It depends on one’s perspective; but clearly, what Chiquita Brooks-LaSure and Liz Fowler said on Wednesday, marked a very big departure from how Seema Verma talked for several years. Instead of Verma’s con- stant references to “market-driven reform,” Brooks-LaSure and Fowler are talking about how the agency’s policies can drive change. And that in itself is a big change. One of the profound contradictions


in Verma’s stated approach was that she constantly asserted that the capitalist marketplace should help to shape the U.S. healthcare system going forward, even as she increasingly pushed down harder and harder on provider organizations to move into two-sided/downside risk, even as providers told her they simply weren’t ready. Provider leaders, particularly NAACOS, became increasingly involved in a sharp-tongued back-and-forth with Verma over her very aggressive statements around downside risk, at the same time that she lauded market dynamics as a way to stimulate healthcare consumer empow- erment. Contradictory? Some saw it thus. In any case, what’s absolutely clear is that Chiquita Brooks-LaSure, Liz Fowler, and their colleagues, have created a philo- sophically consistent statement of policy and strategy when it comes to how they want CMMI to evolve forward—as an instrument of change, aimed at ushering in broader and deeper equity and access into the U.S. healthcare system, while at the same time treating providers better,


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