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Diving brief:
- The Center for Medicare and Medicaid Innovation reorganize its strategy aimed at driving lower costs and improve the quality of government health programs, with an accent on the prevention of chronic diseases.
- The new CMMI approach breaks down into three pillars: promoting the prevention of the disease and helping patients manage chronic conditions; Help beneficiaries achieve health objectives through data access and technology; And support the competition and the choice of health services, such as ensuring that independent and rural suppliers can participate in payment models and design demonstrations on Medicare Advantage.
- The strategy is aligned with the HHS secretary, Robert F. Kennedy Jr., the Make America Healthy Again program, which focuses on chronic diseases, CMMI director Abe Sutton said on Tuesday. “Our system is faced with unsustainable cost pressure,” he said. “We pour resources in the treatment of the disease after the start, rather than fighting deep causes and preventing it.”
Diving insight:
The CMMI was created under the Act respecting affordable care 15 years ago to test new models for payment and health care delivery, with the aim of reducing costs and improving quality in government programs such as Medicare and Medicaid.
However, the agency was faced with certain decreases of the legislators, in particular the Republicans, who argue that the innovation center has not made enough progress on its cost economies and quality objectives.
Last month, the Republicans on the Chamber’s Trade and Meaning Committee sent a letter to Sutton and the CMS administrator, Dr. Mehmet Oz, arguing that the center should revitalize. The letter added that the CMMI had previously promoted a political program, such as improving equity in health, before reducing health spending.
Research has shown that CMMI has not always generated savings for the federal government. An analysis in 2023 of the Congressional Budget Office revealed that CMMI activities increased direct expenses by $ 5.4 billion, or approximately 0.1% of net expenses for Medicare, between 2011 and 2020.
However, the agency has already made some modifications during the second Trump administration. In March, the CMMI said that it would stop four payment models early and cancel two demonstrations before being able to start.
Tuesday, the CMMI took another step towards the overhaul of its operations. The strategy uses what the agency has learned since its creation to revise the American health system, which has been overwhelmed by increasing costs and low -value care, wrote Sutton in a blog article.
The new models of models and revised demonstrations may require that all alternative payment models involve a downward risk, and pushing more drugs from Medicare and Medicaid in arrangements with a financial risk for suppliers, according to a white paper on the strategy.
Disease prevention is also a key objective of the plan and will be incorporated into all models. The objective could include health and nutrition advice or smoking cessation, early detection of conditions Like cancer management and disease services to slow the progression of chronic conditions, such as diabetes and blood pressure control, according to a white paper.
In addition, the strategy aims to help people achieve health goals by providing them access to data. This could include patient -oriented mobile applications to help them manage their health or data transparency tools that could give them information on the costs and performance of suppliers, Sutton said.
The final objective of the plan is to promote the choice of patients and competition between providers. The CMMI wants suppliers who have generally not participated in the agency’s payment models join, including rural clinicians and independent practices, Sutton said.
The center will also try to simplify and standardize its portfolio of models as far as possible, limiting the administrative burden and making participation less complex, he added.
In addition, the agency will move to promote the neutrality of the site – offering the same reimbursement of health insurance, regardless of where the services are provided – and “confronting” non -competitive Certificate of state of laws on needs, which obliges providers to obtain regulatory approval of expenditure and major projects, said Sutton.
Medicare Advantage, the privatized option for the beneficiaries of Medicare, is also on the agenda. The CMMI could test the modifications of the payment of the PLANS MA or the updates of quality measurements which could better align with better health, according to a white paper.
The new CMMI strategy is involved while the Trump administration and the Congress Republicans have moved to reshape large parts of the country’s health sector.
At the beginning of this week, the House Energy and Commerce Committee, which oversees Medicare and Medicaid, proposed its plan to reduce Medicaid spending, including the work requirements and a freezing on the tax provisions of the suppliers that the states use to finance their share of expenses.
The plan will lead to millions of people who lose coverage, which will probably prevent them from accessing health services and hitting the results, experts and suppliers of providers.
