Policy Innovation
The physician’s important role in driving healthcare policy
By Tommy Barletta
[ORIGINALLY APPEARED IN MDNEXT Q4-2022]
With a divided Congress, the focus now turns to the outlook for 2023. It is important to focus on how the Biden Administration plans on spending the time before the 2024 election and how they can leverage the various executive branch levers to impact the healthcare system.
The Center for Medicare and Medicare Innovation (CMMI) is the most powerful tool in the Biden Administration’s tool kit. It possesses the authority to move forward with large-scale and potentially mandatory payment models. CMMI has been largely quiet during the pandemic—out of logical concerns about disrupting a fragile health care system. But as the public health emergency comes to a close, recent developments from
CMMI suggest a more active period to come. In November, CMMI announced the next steps in its strategic refresh and shed some light on where they may look to focus in the years
ahead.
What role can physicians play in influencing the direction of CMMI’s future payment models? More broadly, how can they shape innovation in both payments and health technology that improves outcomes?
CMMI lessons learned—physicians need to play a greater role
CMMI’s stated goal is the development and implementation of payment models that “achieve better care for patients, smarter spending and healthier communities (CMMI Website).” However during their 2021 Strategic Refresh, they found that “only six out of more than 50 models launched generated statistically significant savings to Medicare and to taxpayers.” (CMMI Strategic Refresh).
While reducing spending is not the only metric worth considering, the limited success here when combined with the Administration’s broader health care goals suggests that CMMI is at a crossroads of how to design reimbursement models to improve quality, outcomes and savings for the taxpayers.
I spoke with AngelMD Chief Medical Officer Mark Froimson to get his perspective on how best to move forward with innovative payment models. According to Dr. Froimson, CMMI models like CJR and BPCI produced savings only on the margins because “[CMMI] was hospital centric in their way of thinking due to the strength of the hospital lobby.” They were unwilling to put the responsibility in the hands of physicians. In his view, if CMMI had given that bundled payment to physicians, “they could deliver value because they know where the bodies are buried and where the waste is in the system.”
In the near future, CMMI is likely to consider future and potentially mandatory models that build upon CJR, BPCI and BPCI Advanced. According to Froimson, physicians need to be at the center of driving these innovations. “If you incentivize physicians to be in charge of every dollar prospectively, they will be much better as a general contractor to determine what innovations they need to improve results.”
Oncology and cancer care models—the near term opportunity
A concrete example of the role that physicians—specifically oncologists—have played in both leading innovation, improving care and lowering costs can be seen via the success of CMMI’s Oncology Care Model. This model included roughly one-quarter of Medicare FFS-related-chemotherapy related care and had more than 200 practices participating. The ongoing analysis of the demonstration—which ended in 2022—demonstrated a reduction in overall costs, high quality of care and encouraging levels of patient satisfaction.
In their November report, CMMI called out the successes from the OCM and highlighted the 2023 launch of the Enhanced Oncology Care model. This new model will introduce the concept of downside risk for participants, which provides a powerful opportunity for oncologists to demonstrate how physician-led models can truly be transformative for the health care system.
Technologies leading innovation in payment reform
The conversation about innovative payment models and transforming healthcare delivery is as much about shifting the practice of medicine as it is about the innovative technologies that accelerate those shifts and achieve the performance benchmarks.
With respect to these future models, Froimson believes “it’s not just innovation in payment, [the goal] is to foster innovation throughout medicine, utilizing the levers the a as government…to drive not just innovation in payment design, but to encourage innovation in care delivery.”
Once again, the physician perspective is crucial because of the direct role they play in the patient’s care. “If policy allowed physicians to drive these things, the technology to better manage the financial aspect and [patient care] via remote patient monitoring (for example)—they would be incentivized to purchase innovations that actually improve care,” said Froimson.
Considering that CMMI is in process of planning future models and given the expertise of AngelMD’s 35,000 members, we return to the question of what role should physicians play in developing an Innovation Agenda that helps guide the future of health care delivery. With that in mind, we are interested in developing principles for an AngelMD Innovation Agenda that can be shared across industry, policymakers and the broader health ecosystem.
Tommy Barletta is the founder of Jones Point firm, which provides strategic advisory services to companies and investors impacted by an ever-changing regulatory and legislative environment. The firm leverages its 20+ years of experience in Washington, D.C., and deep Wall Street relationships to advise companies on effective advocacy strategies and guide their execution.
