CMMI's Smith: Agency aiming for tweaks to make its models produce greater savings

Center for Medicare and Medicaid Innovation directors past and present spoke at HLTH's virtual conference this week. (HLTH)

The Trump administration has been conducting a review of advanced payment models launched in Medicare earlier this year and found that while participation has increased steadily, there's still plenty of work to be done to produce savings.

In fact, the agency has found that of more than 50 value-based care models studied, just five were producing savings, said Brad Smith, director of the Center for Medicare and Medicaid Innovation (CMMI).

A number of models instead landed in "the break-even range," and some, including some of CMMI's "bigger models," were operating at a loss, Smith said.

"I think there’s a lot of things we’ve learned going back through these 54 models or so that we’re going to leverage moving forward," Smith said.

Smith spoke on a panel at HLTH's virtual conference this week and was joined by two former CMMI chiefs: Adam Boehler and Patrick Conway, M.D. Boehler is now the CEO of the U.S. International Development Finance Corporation, and Conway is CEO of Care Solutions at Optum.

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Smith said there were no models where care quality suffered, and several did lead to notable quality improvements. He said the agency is looking to make tweaks to existing models that can potentially make them work better and drive even greater participation.

He commended Conway and Boehler's work in rapidly scaling up value-based care models even as he acknowledged they're far from perfect at present.

"Those guys have done a great job of getting participation," Smith said. "The private payers are doing it, the government is doing it at scale. I think that is just a huge success that we can never take for granted."

Smith's words echo recent comments from his superior, Centers for Medicare & Medicaid Services Administrator Seema Verma, who also at HLTH this week slammed Obama-era models as lacking a strong return on investment.

Conway, who helmed CMMI for five years and at its launch under the Obama administration, said the agency initially worked in a "startup" mode, as it had to start from scratch in designing and implementing new models.

CMMI was able to go from 0% of Medicare payments to 30% in advanced alternative payment models, and moving forward, to continue that growth, he said two things are critical: making more models mandatory and more changes permanent.

Mandatory models prevent adverse selection in terms of participants, Conway said, and making models permanent after the demonstration phase is more likely to boost private-sector interest.

"I think private payers are going the same direction," Conway said. "I think we’re past that tipping point and now it’s really driving implementation across the public and private sector."