Priorities in Advancing High-Quality Value-Based Health & Health Care: Opportunities for CMMI

By: Cindy Mann

Prepared for the National Academy of Medicine’s Leadership Consortium for a Value & Science-Driven Health System

Establishment of the Center for Medicare & Medicaid Innovation (CMMI) was a key provision of the Affordable Care Act. For the past ten years, CMMI has sought to identify and assess how alternative payment strategies perform in improving outcomes without increasing costs. To date, nearly five dozen models have been implemented. Although a number have provided delivery improvements and cost saving insights, for example through shifting care to lower-cost sites and strategies, most have not yet demonstrated the level of savings theoretically possible.

As part of an expert panel convened by the National Academy of Medicine, Manatt Health partner Cindy Mann coauthored a communication proposing priority opportunities for CMMI to catalyze progress toward high-quality value-based health and health care.

Starting with the basic assumption that health and health care services must be more integrated and aligned, with each other and with beneficiary needs, the communication outlines four fundamental goals that CMMI can use to sharpen its focus: 1) clearly positioning the beneficiary as the North Star for all activities; 2) assuring the primacy of equity in every decision; 3) fully linking with services aimed to engage the community and social drivers of health; and 4) aligning payers and integration of payments, prospectively designed around incentives for services most important to the health needs of individuals and families.

To expedite the transformations required, the panel suggests that CMMI should enhance its innovation role, adding to its current role of principal model builder a role as principal facilitator.

Twelve other thought leaders participated on the panel and coauthored the communication with Cindy: Mandy Cohen, MD, MPH; Patrick Conway, MD; Julian Harris, MD, MSc; Dora Hughes MD, MPH; Peter Long, PhD; Mark B. McClellan, MD, PhD; David Muhlestein, PhD, JD, MHA, MS; Amol S. Navathe, MD, PhD; Rebecca Onie, JD; Edwin Park, JD; Rocco Perla, EdD; and Meena Seshamani, MD, PhD.

To read the full communication, click here.

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