Policymakers, Industry Leaders Call for Innovation Center Changes

The CMS Innovation Center – otherwise known as CMMI – has been the federal government’s key instrument for healthcare payment and care delivery reform. But lately, policymakers and industry leaders are looking to change the center responsible for change in healthcare.

On Feb. 3, several Representatives introduced a bill that would increase Innovation Center transparency and accountability. The Strengthening Innovation in Medicare and Medicaid Act (H.R. 5741) addresses concerns regarding the center’s ability to “waive certain Medicare and Medicaid rules to test controversial approaches to deliver care without assurance that these changes will not have a negative effect on health care delivery outcomes,” the policymakers explained in a joint statement.

“Innovation is key in health care, and CMMI has an important role in improving health care delivery for the future. However, CMMI currently operates under a poorly defined framework which fails to provide for adequate oversight or transparency,” Representative Adrian Smith (R-NE) elaborated. “This bill would reduce uncertainty throughout the health care marketplace by providing for appropriate oversight of CMMI, while striving for the ultimate goals of lower health care costs and improved quality of care.”

The bill aims to establish “guardrails” for the Innovation Center and allow for more public input. To do this, the bill would require the HHS Secretary to develop and implement a plan to monitor the effects of models run by the center and mitigate any adverse impacts.

The bill would also increase transparency around Innovation Center rulemaking and support rural providers and others with economic hardships through a series of new requirements and processes, including an expedited Congressional disapproval process for models, a new process for public input, including advance public notices, and hardship exemptions, particularly for providers treating vulnerable populations.

“[T]here is bipartisan agreement and recognition that, without additional guardrails and transparency, patient care could be compromised by even a well-intentioned experimental model,” Representative John Shimkus (R-IL) stated. “This legislation would help ensure the CMMI functions as Congress intended, with protections for both patients and providers.”

Members of Congress have expressed concerns about the Innovation Center’s practices in the recent past. Just last year, the House Committee on Ways and Means urged CMS to be more transparent about alternative payment model development undertaken by Innovation Center staff.

The committee members feared that limited transparency of policy changes that can be made “unilaterally by the executive brand” could result in unintended negative outcomes for patients, providers, and the industry at large.

Concerns regarding the Innovation Center’s authority to waive Medicare and Medicaid requirements in the name of healthcare reform have raised alarms among other policymakers, including former Representative Tom Price who later served as HHS Secretary. Price alongside other members of Congress called out the Innovation Center in 2016 for mandating participation in certain alternative payment models. The models in question were later revoked.

But policymakers are not the only ones concerned about Innovation Center practices.

Last week, leaders of the Health Care Transformation Task Force wrote in Health Affairs that the center’s current approach to model design and implementation does not fully support the adoption of value-based care.

“A modernized data system that better supports transformative models and promotes interoperability is a fundamental need,” representatives of the group wrote. Additionally, they called for a greater focus on coordination between models and a regulatory environment “more conducive to value transformation.”

To advance value-based transformation – an effort that many in the Task Force feel has been hampered partly by Innovation Center design – the leaders recommended that the Innovation Center adopt new principles for future innovation, including:

• Focus on model certification and expansion for existing alternative payment models
• Balance innovation and scale to ensure models are large enough to produce valid evaluation results, but small enough to be refined easily
• Adjust savings expectations over maximum savings in the initial years of model testing
• Prioritize model interactions so incentives align across the healthcare industry
• Invest in CMS-based data systems to modernize CMS data infrastructure and boost data sharing with model participants

To date, the Innovation Center has launched over 40 value-based care and payment models with its $10 billion in appropriation. However, the models have not all been successful, according to a 2018 GAO report that found only four models had achieved lower spending and higher quality.

The Trump administration recently tapped former Anthem executive Brad Smith to lead the Innovation Center. Smith, who most recently served as chief operating officer at Anthem’s Diversified Business Group, will lead the center and oversee the development and testing of value-based transformation efforts.

UPDATE 02/24/2020: The Health Care Transformation Task Force on Feb. 11, 2020, wrote to policymakers opposing H.R. 5741. The group stated in the letter to the bill's co-sponsors that the bill "goes further than necessary to address some legitimate concerns, will significantly hamper innovation through added administrative burden, and will give stakeholders who are committed to preserving the status quo new tools to slow innovation based on special interests." 

Specifically, the group expressed concerns with the bill's requirement to transmit a proposal to Congress for the testing, expansion, or modification of alternative payment models at every stage of development and the proposed limits on the scope and duration of Innovation Center models. The letter explained that these provisions constrain the ability of the Innovation Center to innovate and would negatively impact the government's value transformation efforts.

To read the full letter, please click here.