Former Anthem Exec to Lead CMMI, Value-Based Care Efforts at HHS

The Trump administration announced on Monday that it has picked Brad Smith to serve as director of the CMS Innovation Center (CMMI), where he will oversee the development and testing of value-based care transformation in Medicare and Medicaid.

Smith most recently served as the chief operating officer at Anthem’s Diversified Business Group, an arm of the major insurer that is called a “mini-Optum.” He previously co-founded and led Aspire Health, a healthcare company dedicated to providing home-based palliative care services to patients with serious illnesses.

It is this experience that will make Smith successful at CMMI, CMS Administrator Seema Verma stated in the announcement.

“Brad’s experience thinking outside-the-box to improve healthcare as a successful entrepreneur, along with his stellar academic and policy background, have prepared him well to lead CMMI and bring innovative solutions to our healthcare system’s most pressing challenges,” she said.

Smith was also tapped to be HHS Secretary Alex Azar’s senior advisor for value-based transformation, a role previously filled by the former CMMI director Adam Boehler who stepped down in 2019 to serve as the first CEO of the US International Development Finance Corporation.

“Paying for outcomes rather than procedures through CMMI models is an important tool for the value-based transformation of healthcare that President Trump has prioritized,” Secretary Azar said in the announcement. “Brad has impressive experience with innovative care delivery and paying for value, and he will help expand Administrator Verma’s and CMS’s efforts to ensure Medicare and Medicaid beneficiaries are getting better care, and better health, at a lower cost.”

Senate health committee chairman Lamar Alexander (R-TN) also congratulated Smith on Monday, saying Smith’s record of success in healthcare will help him to manage a growing portfolio of value-based care models.

“Brad has exactly the right experience to lead a center charged with coming up with innovative ways to lower health care costs and improve quality,” Alexander said on his website. “He has founded a successful health care company and knows how state and federal governments work, having served under Governor Bill Haslam and Senator Bob Corker, and at the White House. I look forward to working with Brad to give Americans better health care outcomes, better experiences, at lower costs.”

Smith will follow the prolific CMMI career of Boehler who joined the center in April 2018. Under Boehler’s direction, the center launched 16 new value-based reimbursement models, including extensive overhauls of how Medicare pays for primary care and the treatment of chronic kidney disease.

Providers have largely been supportive of the new value-based reimbursement models but many have been calling on the industry to do more with the transition away from fee-for-service. Only about one-third of healthcare payments made in 2018 were tied to an alternative payment model – a value significantly lower than the federal government’s initial goal for that year.

CMMI has been the lead player in developing and testing innovative payment and care delivery models with its $10 billion appropriation for fiscal years 2011 through 2019. However, the center has recently received criticism for its models and how it is run.

In 2019, the House Committee on Ways and Means urged CMS to boost transparency with model development within CMMI. Later that year, two members of the Physician-Focused Payment Model Technical Advisory Committee, which was created under MACRA to make model recommendations to HHS, resigned citing concerns that CMS and CMMI are opposed to implementing the ideas from the committee.

In 2018, the Government Accountability Office (GAO) also reported that only four of the 37 models run by CMMI had achieved spending and quality improvements.

Smith is optimistic that his time at CMMI will bring innovation to healthcare.

“The design of CMMI is intended to be around innovation,” he recently told the Tennessean. “The goal is to really figure out how do we set up the right set of incentives for providers to do the right thing for patients and to empower patients to get better care.”