What's new at CMS's Innovation Center?
The day's formal program began with Patrick Conway, who runs Medicare's innovation center and exhorted the audience on the need to innovate—and do so in a hurry.
Yes, put this on billboards: Patrick Conway #innovatecare14 - We'll either innovate US health care or hit it with blunt cuts. Easy choice— Tom Hubbard (@ThomasEHubbard) February 27, 2014
Conway reviewed some of his priorities and teased the center's future work and influence; for example, he said that officials will make changes to the much-watched Medicare Shared Savings Program based on early lessons from the Pioneer program.
Next year, nearly 7% of hospital payments will be tied to performance metrics. - Dr. Conway. Not pay-for-reporting anymore. #InnovateCare14— Rob Lazerow (@roblazerow) February 27, 2014
Conway also stressed the need for public and private stakeholders to collaborate for success; he shared a striking example of how Bellin Health was essentially punished for participating in payment reforms. Why? Because private payers and the state weren't willing to mimic the feds and reward the system for its push on value rather than volume.
(He also took issue with the recent New York Times article that oddly attacked CMMI's decision to avoid clinical trials. "I was misquoted," Conway joked.)
How the market is shaping health reform
Conway was followed by a panel discussion moderated by Peter Long of the Blue Shield Foundation of California, and featuring Peter Orszag (the former top budget officer under President Obama) and Tom Scully (who ran CMS under President George W. Bush).
The two men sparred over the pace of reform and the role of providers. Scully suggested that hospitals are too comfortable, arguing that they don't face enough competition and haven't been pushed enough to reform.
Scully: in a healthy market, the different providers "hate each other a little bit." Prevents anticompetitive behavior. #innovatecare14— Rivka (@RivkaFriedman) February 27, 2014
Orszag countered that providers are showing an ability to "squeeze themselves" to adapt to new pressures (and theoretically lower costs and deliver better value), such as by constricting their employment.
He also added that steering capitated payments to hospitals via ACOs, rather than to payers through the Medicare Advantage program, is a smarter play to achieve real reforms. (It's worth noting that Scully didn't agree; Medicare Advantage debuted under his watch.)
When it comes to using payment risk to change behavior, "the dividing line" between providers and plans doesn't make much sense, Orszag added.