Future CMS innovation center initiatives could include outcomes-based drug pricing, telehealth

Patients in a hospital waiting room
Both insurers and hospitals want to see a greater focus on value-based payments from the CMMI, according to letters to the agency. (Getty/SuwanPhoto)

The federal Center for Medicare & Medicaid Innovation should focus more on increased interoperability, more value-based payment programs, and expanded telehealth coverage, hospitals and payers say. 

Those were the recommendations which resulted from the CMS Innovation Center's recent request for information from the health industry about which improvements could lower spending and improve outcomes. 

In all, the agency received about 1,000 comments from insurers, associations and providers, with many of those comments focused on speeding the transition to value-based care.

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Medicare "has taken a number of steps over the last seven years to facilitate the movement away from a fee-for-service (FFS) system that rewards volume and towards one that emphasizes value, quality, and innovation, but more can be done to truly transform healthcare payment and delivery,” officials from health insurer Anthem said in their comments. 

The comments from the Indianapolis-based health giant follow concerns from the industry that the transition to value hasn't been fast enough, and more incentives are needed to make providers take on risk and reduce costs. 

RELATED: CMS rebrands Meaningful Use, reduces reporting measures

Anthem also pushed for more interoperability in the meaningful use program and increased information, and the insurer may have already gotten its wish. As part of an annual Medicare payment update, the agency announced it was refocusing the program to interoperability and mandating an update to 2015 Certified EHRs beginning next year.

Hartford, Connecticut-based insurer Aetna, on the other hand, pushed for telehealth flexibility in Medicare Advantage plans, a position which CMS Administrator Seema Verma has hinted she supports.

Patient access to care is particularly difficult in rural areas, where providers are few and far between. Proponents of telehealth say it can increase access and even lower costs by removing transportation barriers and reducing costly hospital admissions, but coverage under Medicare is still in its early stages

Hospitals also took a particular focus on value-based payments, in particular, pointing to runaway drug costs.

RELATED: Pharma group blames lack of outcomes-based drug contracts on regulatory red tape

The American Hospital Association (AHA) recommended that the agency consider voluntary risk-sharing contracts with drugmakers that link prices to health outcomes. Such contracts already exist for private insurers, but the National Pharmaceutical Council has said regulatory barriers exist that make expansion of these plans difficult. 

AHA also pushed for innovative models that would carve out behavioral health services from the Medicaid managed care benefit and expansion of current models already in place, like the value-based insurance design model.

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