The Center for Medicare and Medicaid Innovation (CMMI/Innovation Center) has revealed three pillars that will guide Medicare and Medicaid strategies as part of President Donald Trump’s “Make America Healthy Again” (MAHA) mandate.
Abe Sutton, CMMI director and deputy administrator for the Centers for Medicare & Medicaid Services (CMS), authored the paper, “CMS Innovation Center Strategy to Make America Healthy Again,” which was released May 13.
Sutton referenced the CMMI’s work over the last 15 years, which consisted of testing “alternative payment models that positioned states, payers, health systems and providers as the catalysts for change. The goal of these tests is to improve quality and outcomes and reduce costs for taxpayers.”
Now, given the Trump administration’s directive, Sutton said CMMI’s vision “is to take the learnings from these investments to build a health system that empowers people to drive and achieve their own health goals and Make America Healthy Again.”
Among those goals, Sutton said in the paper, “Health care remains local. People want evidence-based programs, information and choices that empower them to attain the care they need in their communities. They want this care from the organizations of their choosing, delivered in a manner that is convenient, accessible and effective. This might include care that is virtual, digital in nature, at an office, or provided in the home.
“Regardless, the choice should be one that people (and the caregivers who support them) are empowered to make as consumers.”
How CRT answers this call
In keeping with goals shared by new CMS Administrator Mehmet Oz, M.D., after taking office in April, Sutton shared “three interrelated strategic pillars” to “support the varying needs of the populations the Innovation Center serves.”
The pillars were to promote evidence-based prevention; to empower people to achieve their health goals; and to drive choice and competition for people [patients].
“The pillars are underpinned by a foundational principle, which is to protect the federal taxpayer, in line with the Innovation Center’s statutory mandate to produce cost savings,” the paper said. “As responsible stewards of federal taxpayers’ dollars, the Innovation Center will focus on models that show the greatest promise for generating savings and improving quality.”
Without mentioning Complex Rehab Technology (CRT) specifically, Sutton’s repeated descriptions of building a health system that will motivate health-care providers to deliver “high-quality, efficient care and improve the health outcomes of their patients” can be interpreted as affirming such interventions as CRT, which has been shown to lead to better outcomes and to reduce the risk of conditions such as pressure injuries.
For example, the Functional Mobility Assessment (FMA) and other tools that gather feedback from wheelchair riders could support Sutton’s focus on evidence-based prevention. Calling prevention “the cornerstone of healthy living,” Sutton advocated for disease management “to slow the progression of chronic disease and improve outcomes.” The ability of optimally configured CRT seating systems to slow or prevent the progression of scoliosis and asymmetrical postures would be right in line with Sutton’s goal of managing chronic conditions.
“Models will promote access to and use of evidence-based preventive services known to improve outcomes for people and reduce costs to the health system,” Sutton wrote. Power seating functions on power wheelchairs and power-assist devices for self-propelled manual wheelchairs could certainly prevent repetitive strain injuries that cost significant time and money to heal.
Sutton’s paper did specifically mention durable medical equipment and its importance in supporting patients in their homes: “Models could grant providers access to new waivers that give flexibility to deliver and incentivize preventive care. For instance, we will explore waivers for accountable care entities that assume global risk to provide durable medical equipment that may bypass national coverage determinations if they support transition to or remaining in the home.”
Tools such as the FMA would also fit the Innovation Center’s goal of determining the efficacy of preventive care policies. “Model tests and evaluations must be designed to identify the most successful preventive care policies and demonstrate their impacts on health outcomes and costs,” Sutton said. “Models will ensure that quality measures and evaluations are focused on the preventive health outcomes that matter most to people. … In some cases, the impact of prevention will take place over a longer period, and we will seek intermediate markers to track success.”
The Innovation Center will also “continue to test and scale models in which all beneficiaries are receiving care from entities with direct accountability for health outcomes and costs. Global risk and total cost of care models in original Medicare, Medicare Advantage, and Medicaid provide the flexibility in payment and care delivery to optimally use data and other tools to promote health.”
Providing rewards for better care
“Models can provide an opportunity for independent providers and practices to be rewarded for better care while also promoting patient choice in both coverage and sites of care,” Sutton added, which could again support patients who want to live at home rather than in care facilities. “Innovation Center models will be designed to level the playing field for providers practicing independently and outside of health system or health plan ownership to increase competition in markets. Models may expand the use of advanced shared savings and prospective payments to support independent provider practice participation in models. … New models or tracks within models will spur competition by stimulating and supporting a wider variety of participating providers and practices, such as those in rural communities as well as those who focus on complex care and specialty populations.”
Medicare Advantage (MA) models “will be designed to increase high-value coverage options and to help beneficiaries select plans that best meet their health needs. Features of a model could include testing changes to payment for MA plans, such as testing the impact of inferred risk scores, regional benchmarks, or changes to quality measures that better align with promoting health.”
Innovation Center models would use expanded shared savings and prospective payments to encourage independent providers to participate.
Ultimately, Sutton wrote, all of these plans would strive to “shift financial risk from taxpayers. The work described in the pillars above has potential to birth a system that drives savings based on health promotion and relies less on expensive models of care.”
As next steps, the Innovation Center “will focus on testing models that transform the U.S. health system into one that builds healthier lives — through prevention, individual empowerment, and choice and competition,” Sutton said. “Along with private sector activity, we will realize a vision in which people achieve their health goals and the providers caring for them are directly accountable for their health outcomes and the costs of their care.”
