ViVE 2023: Current and former CMMI chiefs reflect on past, future of agency

NASHVILLE, Tennessee—As the Center for Medicare and Medicaid Innovation (CMMI) settles into its second decade, its leadership is now making it a priority to take the lessons learned from the first 10 years into its next 10.

The ViVE Conference this week convened three past and present leaders at CMMI to discuss the agency's history and how it's poised for the future. Current CMMI Director Liz Fowler, Ph.D., was joined by her predecessors Brad Smith, the founder of Russell Street Ventures, and Adam Boehler, the founder of Rubicon Founders.

Boehler said CMMI has been through several phases in its history, and, when it initially launched thanks to the Affordable Care Act, the goal was to test until something stuck.

"In the first CMMI phase, it was kind of let a million flowers bloom," he said. "Try a lot, we don't know what's going to work."

During his tenure, the team pivoted to digging more deeply into that soil, seeking more clarity on successes and failures and consolidating models where it made sense, he said.

Fowler, who was working in the Senate at the time CMMI was developed, said that while the agency is "not necessarily what we thought it would be" during its creation, it's grown to the point where there are clear throughlines she and her team can follow as they chart the course to new models.

"I think we've learned what works and what doesn't," she said. "I think we're past the point of throwing spaghetti at the wall and planting a lot of seeds, and now really trying to home in on what can work."

Smith, who succeeded Boehler at the tail end of the Trump administration, said his team was tasked with reviewing the models developed by his predecessor, namely the Direct Contracting model that evolved into the current ACO REACH program.

Through that experience, he said he saw how easily CMMI could end up capitulating to industry pushback and pressure, which would kneecap its more innovative, money-saving models. Getting stakeholders to cut costs is hard and requires a strong person at the helm, he said.

For example, the proposed Radiation Oncology model caused a huge stir in the industry, and, amid the political pressure, the Centers for Medicare & Medicaid Services decided last summer to indefinitely delay the model.

"People have to understand that to save money isn't easy and it's not necessarily going to be politically popular," Smith said.

For her part, Fowler acknowledged CMMI's mixed track record to date and highlighted the agency's multipronged strategy for the future, which includes a focus on health equity, more transparency around performance data and finding ways to work more closely with private payers.

Fowler added that her team is also mulling ways it can look outside of the traditional scope of a payment model to drive change. During Boehler's tenure, he tackled this idea by launching a challenge around the use of artificial intelligence.

"We’re looking down that line and trying to think of what more we could do that’s sort of outside the realm of traditional models," Fowler said.