Lawmakers call on CMMI to be more transparent and accountable as model review continues
A group of bipartisan lawmakers want the Center for Medicare and Medicaid Innovation (CMMI) to be more transparent in its management of value-based models of care as the center pursues a major overhaul of its demonstrations.
The 24 lawmakers sent a letter to CMMI director Liz Fowler on Wednesday seeking more information on the centre’s decision-making process on the value-based models of care it oversees. The letter comes less than a month after Democrats raised concerns about several parts of the direct contract model.
“As we look to the future of CMMI, we believe it will be stronger with greater transparency and increased stakeholder participation,” the letter said. “We believe in greater use of real-time data to immediately understand the impact of models on healthcare providers and patients so that decisions can be made quickly about the value of a demonstration. “
Lawmakers want CMMI to share its plans on how it can be more transparent and its actions to “reflect its intended mission, to demonstrate projects of limited scope and duration to test new payment and delivery concepts.”
The letter said that CMMI’s licensing law, which was part of the Affordable Care Act, calls for the center to seek feedback from interested parties. However, this requirement was often put aside by the center and rarely respected.
“We believe that CMMI could strengthen the development of its model by enabling greater stakeholder engagement,” according to the letter led by Representatives Terri Sewell, D-Alabama, and Adrian Smith, R-Nebraska. “In addition, Congress and the public need to know how the results will be sampled and evaluated and which beneficiaries are likely to be affected.”
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The Department of Health and Human Services (HHS) is also expected to disclose the modeling that produces estimates of savings and how the quality may be affected. Lawmakers feared that the modeling was biased “in favor of savings rather than improving the health of beneficiaries or addressing health disparities,” the letter said.
The Centers for Medicare & Medicaid Services did not immediately return a request for comment on the letter.
Fowler admitted the center “can do a better job of letting Congress know where we’re going,” she told Health Affairs editor Alan Weil in an interview Thursday.
The goal is to make sure Congress knows “the direction in which we are heading,” Fowler said.
His remarks come as CMMI continues to evaluate several payment models, some of which have been suspended or delayed. Fowler said Thursday that she hopes to install a more “patient-centered” view for models at the center.
Sewell and Smith’s letter is the latest missive from lawmakers concerned with part of the center.
Representatives Bill Pascrell, D-New Jersey, and Mark Pocan, D-Wisconsin, wrote to CMMI and HHS last month Calling for a freeze on the direct contracting program, which calls on providers to obtain captive and partially captive payments for the delivery of care.
Lawmakers feared that the insurer-based global and professional direct contract model would automatically enroll traditional Medicare beneficiaries into Medicare Advantage plans.
“It is not yet clear how CMS will ensure that beneficiaries can revert to traditional health insurance, or even how CMS will notify beneficiaries that they have been automatically enrolled with an insurer. [direct contracting entity]”, read the letter.” We are concerned that directing people to Medicare Advantage-type plans not only eliminates the choice of beneficiaries, but also erects more barriers and providers less consumer protections for them. beneficiaries. “
CMMI will not have an application period for direct contracts this year, but lawmakers want the program to be completely suspended.