CMMI takes 'one-shot' opportunity at health care innovation

Official: 'We're halfway through our funding already'

The Center for Medicare and Medicaid Innovation (CMMI) has already spent billions on new projects designed to improve quality and reduce costs, a senior CMMI adviser said last week, CQ HealthBeat reports.

According to CMMI's Hoangmai Pham, the agency has intentionally frontloaded spending on a handful of priorities, which include projects intended to:

  • Encourage efforts by doctors and hospitals to coordinate care;
  • Reduce deaths from cardiovascular disease;
  • Promote statewide health system restructuring by combining the health care purchasing power of business and government; and
  • Get physician offices to manage chronically ill patients and practice preventive care.

The unprecedented level of political will and market investment in health care innovation could make CMMI and its $10 billion budget a "one-shot" deal, Pham says. The agency has already spent nearly half of its initial funding, Pham added.

  • Right before Thanksgiving, CMMI announced a trial period, limited-risk option for bundled payments. Get our take.

HHS granted power to push its programs

CMMI has been given an unusual and potentially outsized charter, partly because the Affordable Care Act grants HHS powers to promote its innovation projects unlike ever before, CQ HealthBeat notes. The agency can scale up health care payment and delivery models that show promise in saving Medicare and Medicaid dollars without having to wait on an act of Congress.

In addition, CMMI has also been "given unique waiver authority," Pham notes—a power that allows the Center to waive specific payment and eligibility rules to pursue projects.

While CMMI enjoys several high-profile supporters—including renowned surgeon and journalist Atul Gawande, who has applauded the agency's innovative measures—some critics have questioned the value of the Center, and suggested that CMMI could be shaped by political power shifts in the future.

Moreover, Pham notes, "A lot of people are not sure this is what government should be doing."

Given the rare and potentially fleeting opportunity the Center has to innovate, Pham notes that CMMI has made "huge investments" in shared learning. "If you have one shot and no do-overs, you do not leave any data on the table" (Reichard, CQ HealthBeat, 11/21 [subscription required]).


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