At PQA, CMS Veteran Blum Highlights Policy Shifts and Rationale for Latest Rulemaking

In a lunchtime discussion with the head of the Pharmacy Quality Alliance (PQA) during the 2022 Annual Meeting Wednesday, the principal deputy administrator and chief operating officer of CMS, a veteran of the agency, highlighted some of the policy shifts made over the past year.

Micah Cost, PharmD, MS, PQA’s CEO, kicked off the conversation with Jonathan Blum, MPP, by asking him to touch on the agency’s goals and measures for success. Blum returned to CMS in July 2021; he was previously at the agency from 2009 to 2015.

“We have challenged the entire organization to really organize around the sense of, we are a steward, a very trusted partner, and really a catalyst for health system reform,” said Blum.

He referenced the revamp of CMS last year around 6 pillars that underscore and drive the agency’s work: advancing health equity, expanding health care access, engaging partners, driving innovation, protecting funding through accountability, and promoting excellence in operations.

“The country needs to hold CMS accountable, to demonstrate what that means,” he said. “We pay a lot of attention to how we operate, the claims experience, the claims processing, how we set quality metrics, how we hire, how we contract, how we build technology systems.”

Cost asked Blum to expand more on the idea of medication use quality, and Blum shared some of what CMS has learned from the COVID-19 pandemic.

Those who were most affected in terms of morbidity and complications were “those that had the greatest need for health care, health care resources, those who have multiple chronic conditions, those who are bound to an institution that cannot transition home,” he said. Blum said CMS is taking a more “macro” look at data, and said it has “focused too much on the mechanics, how we set quality measures, how we set benchmarks.”

As a result, “maybe you've lost the moral vision for what we want to see our health care system. What do we really care about? What do we want patients, consumers to have when they navigate the health care system?”

Looking ahead, Blum said, any conversations about quality have to recognize what the pandemic has illustrated over the past 2 years—that patients who were in the most dire need of health care, including those with multiple chronic conditions, had the least amount of access.

Related to that, the discussion turned to the subject of nursing home staffing, safety and quality; President Joe Biden announced the priority in his State of the Union address, and HHS subsequently released a proposed rule where it is seeking input on minimum staffing requirements. Blum said the agency spoke directly with patients in different parts of the country.

“They told us the greatest challenge they have is not consistent staff, not regular staff, staff that had too much to do that couldn't attend to their daily needs,” he said.

Last week, CMS also released its final rule for 2023 Medicare Advantage (MA) and Part D plans. Among the changes, the agency is delaying by 1 year the time for plans to pass price concessions they get from pharmaceutical companies on to beneficiaries at the pharmacy counter. In the proposed rule, Part D plans would have to start passing on the savings at the point of sale on January 1, 2023, but now they have until January 1, 2024.

In addition, the rule also sets stricter requirements for network adequacy; revises marketing and communication regulations; quality ratings for MA and Part D plans; medical loss ratio reporting; and other changes.

“We want to have tougher, tighter standards for how we think about contracting with both Part D plans and with Medicare managed care plans,” Blum said.

“To me what the final rule says is we are going to be a stronger demander of federal quality care, more clear care, more integrated care, care that beneficiaries can depend on and really begin to elevate the standards for what we believe is better care.”