Reforming the Healthcare Delivery System

At the America’s Health Insurance Plans (AHIP)’s National Conference on Medicare and Medicaid and Dual Eligibles Summit in Washington, DC, taking place September 28 to October 3, Patrick Conway, deputy administrator for innovation and quality and chief medical officer for CMS, spoke on the future of delivery system reform.

During his talk on Tuesday, Dr Conway announced that CMS is likely going to put out a request for information for health plan innovation. Although he didn’t go into much detail, he did say that health plan innovation is critical and CMS is looking for suggestions for adjustment.

“We’re thinking about things like plan design, including but not limited to value-based insurance design; thinking about care delivery issues, like telehealth and hospice; we’re thinking about beneficiary and provider engagement, and are there ways we can adjust to allow you to achieve higher quality and lower cost for beneficiaries,” Dr Conway said.

He went on to discuss the State Innovation Models Initiative, which challenges states to redesign care for their states by working with payers, providers, and other stakeholders. In round 1 there were 6 states in testing and 19 that had designed plans. For round 2, 34 states have applied to either design or test their plans and in November, CMS will announce another round of awards.

“So you have the majority of states in the US transforming care,” Dr Conway said. “We think real change will happen at the state level.”

Among the points he touched upon in his session was the fact that CMS is working with providers, consumers, and purchasers in the healthcare management community to define quality measure sets.

“The goal is really to align use in the public and private sector,” he said, pointing out his own experience as associate vice president of outcomes performance at Cincinnati Children’s Hospital and knowing the difficulty of misaligned measures.

He said CMS is testing new service and delivery models that can be scaled across the nation. There are 3 criteria these models will have to meet: quality goes up and cost is neutral; cost goes down and quality is neutral; or quality goes up and cost goes down.

According to Dr Conway, the marketplace is making a huge bet with CMS that the move to bundled payments will be successful. There are thousands of hospitals, physician groups, and post-acute care groups in bundled payment models, he said. And CMS is constantly looking to improve and make changes to the program.

“This is very different than traditional CMS demonstrations where you launched the demonstration, it ran for 5 years, and 3 years later you post a report on the website,” he said. “We are learning in rapid cycle and adjusting the models as we go, getting monthly and quarterly data feeds.”