Lawmakers call for CMMI to be more transparent and accountable as model review continues

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Lawmakers say the Center for Medicare and Medicaid Innovation needs to improve its stakeholder engagement, including interacting more with Congress over the development of its value-based care payment models. (Getty Images)

A group of bipartisan lawmakers wants the Center for Medicare and Medicaid Innovation (CMMI) to be more transparent in its handling of value-based care models as the center continues a major overhaul of its demonstrations.

The 24 lawmakers sent a letter to CMMI Director Liz Fowler on Wednesday seeking for more insight into the center’s decision-making process on value-based care models it oversees. The letter comes less than a month after Democrats were concerned over several parts of the Direct Contracting Model.

“As we look towards the future of CMMI, we believe it will be stronger with greater transparency and increased participation from stakeholders,” the letter said. “We believe in greater use of real-time data to immediately understand the impact of models on healthcare providers and patients so that decisions can be made quickly about the value of a demonstration.”

The lawmakers want CMMI to share its plans on how it can be more transparent and its actions to “reflect its intended mission, to carry out demonstration of projects of limited scope and duration to test new payment and delivery concepts.”

The letter said CMMI’s authorizing statute, which was part of the Affordable Care Act, calls for the center to gather input from interested parties. However, this requirement has often been shunted aside by the center and rarely observed.

“We believe that CMMI could strengthen its model development by allowing more stakeholder engagement,” according to the letter led by Reps. Terri Sewell, D-Alabama, and Adrian Smith, R-Nebraska. “Further, Congress and the public need to know how results will be sampled and evaluated and which beneficiaries stand to be affected.”

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The Department of Health and Human Services (HHS) also should disclose the modeling that produces estimates of savings and how quality can be affected. The lawmakers were concerned that modeling has been biased “toward savings rather than improving beneficiary health or addressing health disparities,” the letter said.

The Centers for Medicare & Medicaid Services told Fierce Healthcare it received the letters and will respond accordingly.

Fowler did admit that the center “can do a better job of letting Congress know where we are going,” she told Health Affairs Editor-in-Chief Alan Weil during an interview Thursday.

The goal is to make sure Congress knows “the direction we are heading,” Fowler said.

Her remarks come as CMMI continues to evaluate several payment models, some of which have been paused or delayed. Fowler said Thursday that she hopes to install a more “patient-centric” vision for the center’s models.

Sewell and Smith’s letter is the latest missive from lawmakers who are concerned over a part of the center.

Reps. Bill Pascrell, D-New Jersey, and Mark Pocan, D-Wisconsin, wrote to CMMI and HHS last month calling for a freeze to the Direct Contracting program, which calls for providers to get capitated and partially capitated payments for delivering care.

The lawmakers were concerned that the insurer-based Global and Professional Direct Contracting Model would auto-enroll traditional Medicare beneficiaries into Medicare Advantage plans.

“It remains unclear how CMS will ensure beneficiaries will be able to switch back to traditional Medicare, or even how CMS will notify beneficiaries that they have been auto-enrolled into an insurer [direct contracting entity],” the letter said. “We are concerned that funneling people into Medicare Advantage-like plans not only eliminates beneficiary choice but also erects more barriers and providers fewer consumer protections for beneficiaries.”

CMMI will not have an application period for Direct Contracting this year, but the lawmakers want the program to be paused altogether.