Posted on November 21, 2017

NEHI Submits Recommendations to CMS to Help Shape Future Direction for its Innovation Center

WASHINGTON, DC, November 21, 2017 – NEHI (the Network for Excellence in Health Innovation) yesterday submitted recommendations to the Centers for Medicare and Medicaid Services (CMS), in response to the Request for Information soliciting proposals for “new directions” for the Center for Medicare and Medicaid Innovation, or CMMI. Also known as the CMS Innovation Center, CMMI was created under the Affordable Care Act to test models of health care payment and delivery that reduced program expenditures in Medicare, Medicaid, and the Children’s Health Insurance Program, while preserving or enhancing the quality of care.

The request for information issued by CMS in September 2017 sought input from stakeholders to ”promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes,” according to the request.

NEHI’s recommendations to CMS span the following focus areas:

1)       Prescription Drug Models: 

  • The U.S. health care system must develop and operationalize new and innovative ways to pay for highly innovative, high-cost new therapies that will enter the U.S. market in the coming years. Citing its recent white papers on Value-Based Contracting, NEHI recommended that the Department of Health and Human Services, CMS, CMMI, and other relevant agencies coordinate on the design of an initiative that will allow eligible entities to develop and test diverse models of prescription drug payment.
  • In order to advance these payment arrangements, NEHI suggested that new regulations and/or safe harbors in existing regulations, as well as new agency guidance, may have to be issued, as spelled out in NEHI’s white papers. 

2)      Expanded Opportunities for Participation in Advanced APMs; Consumer-Directed Care & Market-Based Innovation Models; Physician Specialty Models; Medicare Advantage Innovation Models; State-Based and Local Innovation, including Medicaid; and Mental and Behavioral Health Models: 

  • Referencing insights from its “Health Care Without Walls Initiative,” NEHI believes that opportunities now exist for the federal government to spur the movement of care into more distributed directions, including in the Medicare and Medicaid programs, and, in particular, through encouraging innovation in Medicare Advantage, the various types of Medicare Accountable Care Organizations, and other advanced alternative payment models.
  • NEHI strongly believes that CMS and the Innovation Center should examine, propose, and test other potential payment models that would support more distributed provision of care where clinically useful and appropriate.
  • NEHI recommends that the Innovation Center announce new rounds of Health Care Innovation Challenges to spur development and testing of other distributed care models, and unleash the creativity of the health care system and technology providers.
  • NEHI also expressed the hope that the Innovation Center would maintain its interest in the Accountable Health Communities model and other efforts to bridge the gap between clinical care and social services. NEHI stressed that CMS and CMMI have an ongoing need to help forge innovative partnerships to address the social and economic determinants of health. Among other costs, these upstream drivers of poor health status frequently predispose people to avoidable health care utilization, with the costs borne by government health programs and society as a whole.  

Click here to read NEHI’s full comments to CMS.

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About NEHI (the Network for Excellence in Health Innovation):

NEHI is a national nonprofit, nonpartisan organization composed of stakeholders from across all key sectors of health and health care. Its mission is to advance innovations that improve health, enhance the quality of health care, and achieve greater value for the money spent. NEHI consults with its broad membership, and conducts independent, objective research and convenings, to accelerate these innovations and bring about changes within health care and in public policy

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