CMMI's Smith: Agency taking hard look at existing payment models

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The Center for Medicare and Medicaid Innovation is digging into its models to improve their performance. (Sarah Stierch/CC BY 4.0)

The new federal health innovation chief said Wednesday the agency is taking a hard look at its existing payment models to find ways to bring them up to snuff. 

Brad Smith, a former Anthem executive and entrepreneur, was named director for the Center for Medicare and Medicaid Innovation (CMMI)—part of the Centers for Medicare & Medicaid Services (CMS)—in January. 

Smith said in a fireside chat at the Virtual Summit on Health System Recovery from the COVID-19 Pandemic that the first order of business after taking the role was to dig into the return on investment of CMMI’s dozens of existing models. 

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Smith said he found that just five models were producing statistically significant savings to the federal government, and none were leading to sustained quality improvements over multiple years. 

“We have this great team working on it," he said. "And while we have seen some progress, we have a long way to go."

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Smith added that the agency is considering further models as well that could launch by the end of the year. Models launched recently by CMMI include new programs targeting the cost of ambulance services, primary care and kidney care. 

Smith said that CMMI is also rethinking its operational model. In the decade since it was formed under the Affordable Care Act, the teams behind various payment models have worked in silos, conducting separate analyses on performance. 

He said streamlining those processes is one way CMMI is considering as it works to “figure out what’s best way to get most data to participants as quickly as possible.” 

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Smith acknowledged the challenges that participants in alternative payment models are facing amid the COVID-19 pandemic. He said that’s why the Trump administration earlier this month announced steps to offer greater flexibility to navigate the models while tackling the novel coronavirus. 

CMS delayed the start date of its new Direct Contracting model to April 2021 and extended the Next Generation ACO program through the end of next year, for example. 

Smith said one of the goals in offering that flexibility was to show CMMI is not backing down from its commitment to value-based care. 

“I think if COVID did anything, it made us even more committed to moving forward aggressively,” he said. 

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