AUSTIN, Texas—Patrick Conway says people are always calling him a gorilla.
That’s because the agency he works for, the Centers for Medicare & Medicaid Services, is viewed by many as the proverbial “800-pound gorilla” in healthcare, acting as the driving force for change in areas like payment reform.
But the reality is that private-sector payers are also major catalysts for innovation in their own right, Conway said during a session at the 2017 AHIP Institute & Expo on Wednesday.
And “if we go together in the same direction, that’s where it gets really interesting,” he said.
Collaboration between CMS and commercial payers is also helpful for providers as they also strive to adjust to new payment models, added Conway, who is CMS’ chief medical officer and deputy administrator for innovation and quality.
“I’ve been on the provider side where you had to deal with many public and private payers, and if you’re getting a common signal from your public and private payers, it’s much easier to improve—and improve at a much faster rate,” he said.
That said, CMS’ work in furthering value-based payment models is expansive—and growing.
The Center for Medicare & Medicaid Innovation, for example, is currently testing 26 major models with the goal of improving quality and lowering costs, and if effective, scaling them nationally. The Congressional Budget Office estimates that CMMI is a $34 billion net saver—a number that has gone up over the years as the models evolve.
“None of the legislation on the Hill does anything to change the innovation center” he added, referencing Republicans’ effort to repeal and repeal the Affordable Care Act.
CMS also currently has more than 500 accountable care organizations, Conway said. Further, the number of two-sided risk-bearing ACOs has also ballooned from only 20 two years ago to currently about 120. “I think we could easily have 200-plus risk bearing ACOs next year,” he added.
Conway is also enthusiastic about Track 2 of the Comprehensive Primary Care Plus Model, which over time, will make 60% of the payments to primary care providers population-based.
“What we’re seeing in those practices; they do not care at all about office visits anymore—in a good way,” Conway said. The idea is to incentivize treating patients only as much as necessary, and in the best venue necessary, which, for example, can mean home visits for elderly patients.
On the state level, Conway outlined how Vermont and Maryland are taking advantage of state innovation grants to create an all-payer ACO model and an all-payer hospital global budget model, respectively.
Maryland’s experiment, for example, which dramatically ramped down fee-for-service payments to hospitals in favor of population-based payments, helped the state both dramatically lower costs and improve the quality of healthcare delivered.
Notably, the state is also remaining committed model despite a regime change from a Democratic governor to a Republican. “
This also shows you this is not a partisan ideal—it’s better healthcare for a population and a state,” he said.