Gabriel Perna | September 8, 2021
Public-private sector partnership was top of mind from leading federal and state government officials at the Health Evolution Summit 2021. But while the government officials discussed the necessary alignment needed between stakeholders in response to the COVID-19 pandemic, the need for collaboration will extend into the post-pandemic future.
“Health system reform and health system transformation need innovators. We need capital investment and new ideas and strategies. And the role of CMMI is to help clear the path for innovators and clear some of the regulatory hurdles that might be a barrier to good ideas and to be able to test those ideas. And in that way, we can help set the stage for that investment and those new ideas,” said Liz Fowler, PhD, Director of the Center for Medicare and Medicaid Innovation (CMMI).
Fowler was joined by Meena Seshamani, MD, PhD, Deputy Administrator and Director of the Center for Medicare, Mandy Cohen, MD, Secretary of the North Carolina Department of Health and Human Services, and moderator, Mark McClellan, MD, PhD, Robert J. Margolis Professor of Business, Medicine, and Policy, and founding Director of the Duke-Margolis Center for Health Policy at Duke University.
Fowler said she wants it to be easier for health care organizations to partner with CMMI to create new models of care, something the agency has been criticized for in the past. She added that better multi-payer alignment with private payers, purchasers, other public payers like departments of health at the state level of Medicaid agencies is vital to CMMI’s overall strategy.
“A lot of CMMI is built on the idea of public-private collaboration. The idea behind this innovation is that we learn from the private sector, and we try to take that and see what can be used and implemented and expanded in the public sector,” Fowler said. But while she is bullish on this kind of collaboration, particularly with regards to innovators looking to partner with federal and state agencies, she cautioned against those who are investing into this space for the wrong reasons.
“We need investors who are interested in health care because they’re passionate about helping patients or improving the health system. Not those who are looking for a quick buck and figured out how to game the system,” Fowler added.
Federal government recommits to value-based care
Both Fowler and Seshamani were optimistic on the federal government’s commitment to using these value-based care models to advance primary care, address social drivers of health, lower costs, and create sustainable models. At the Summit, Seshamani announced results for ACOs participating in the Medicare Shared Savings Program in 2020. In total, ACOs in that program earned performance payments totaling nearly $2.3 billion while saving Medicare approximately $1.9 billion.
“For us on the Medicare side…we’re going to be doing breakdowns of this performance in the Shared Savings program, looking at diversity of the beneficiary population, looking at geography, vulnerable populations,” Seshamani said. “How do we get more beneficiaries involved in these holistic models? And how do we better align incentives and align our programs and metrics across the continuum…and encourage movement along this value-based care continuum with an eye towards advancing health equity, driving that high-quality person-centered care, and really looking at affordability and sustainability?”
Like Fowler, Seshamani sees a lot of private-public opportunities within the Medicare Advantage program to address the social determinants of health. She said many Medicare Advantage plans have been innovating with options such as meal delivery and transportation. She also sees opportunities within Medicare programs to create better transparency, plan navigation, language accessibility and beneficiary support. But it goes beyond Medicare, Seshamani noted, as Medicaid and the ACA marketplace can be other areas for shared learning between public and private sector entities.
“We need to make sure that there is accountability and value in what is being provided for beneficiaries. This means better data transparency so that we can know where the money is going, how it is being used, what is effective, what is not effective. That’s part of the continuous learning that all of us have to do in health care, because unless I am missing something, healthcare is very complex, and there is not a silver bullet,” Seshamani said.
Liz Fowler, CMMI
Both Fowler and Seshamani agreed that the journey to value-based care from the government’s perspective has had a few bumpy spots, with momentum slowing in the last few years. Health systems and providers have either scaled back efforts to transition to value-based models or consolidated with other systems in response to these changing market pressures. Fowler said that one of the biggest lessons CMMI has learned since it was created in 2011 is to communicate more clearly to stakeholders on the direction the federal government is taking with regards to value-based care.
“We need to be doing fewer models, and we need to be really laser focused on health system transformation. The days of letting a thousand flowers bloom, they’re gone. And similarly, multiple bundles and separate APMs for every specialty group also might not work,” Fowler said.
Seshamani added that it’s important to listen to stakeholders when trying to create sustainable new models of care. “With everything that we do, number one, we have to listen to stakeholders, we need to incorporate information and data perspectives that are out there. And then as we are working on programs, we have to be able to iterate and see what impacts there are because there can always be consequences and you have to learn as you go along,” Seshamani said.
ARP provides a lifeline for increased public-private collaboration
One of the biggest potential sources for public-private sector collaboration is the funding from the American Rescue Plan, the $1.9 trillion stimulus fund passed signed by President Biden in March. Cohen said the lessons learned from COVID can be applied to using the money to advance population health, improve data infrastructure that connects public and private entities, address social determinants of health and health equity, and more.
“The entire COVID response has been a partnership. We could have never been successful if we tried to do this from the government space alone, or just the private sector space. It was an important collaboration for both sides and I think it will be important, obviously, as we continue to go forward,” said Cohen.
Cohen added that there is an enormous opportunity for the private sector to work closely with states within their localities to think about how the ARP dollars are spent in a strategically aligned way. “We’re all very good at spending money but can we do it in a way that actually moves the needle on health, moves us to create some of that change management and infrastructure that we need to see the reality come from these value-based payments to move to telehealth permanently, to make sure that we’re looking at equity permanently?” she said.
That issue was reiterated at the Health Evolution Forum’s Roundtables on Community Health and Advancing Equity and New Models of Care Delivery meetings during the Summit. At the Community Health Roundtable, Cohen noted the importance of using ARP dollars for public-private collaboration and at the New Models of Care Delivery Forum Roundtable, McClellan discussed the need to align public and private entities. In particular, he said, CMS is interested in aligning metrics for health plans, providers, and employers. In fact, Fowler said during her session that she didn’t see direct contracting as different or distinct from other alternatives or ACO models.
“CMS takes care of standard risk adjustment approaches and standard metrics for the Medicare program, but they’re interested in aligning that with employers and with what states like North Carolina, Washington, California, and many others are doing to try to get to more aligned support for these payment reforms,” McClellan said during the Forum meeting.