Tuesday, May 15, 2018

Very Brief Blog: GAO Issues Report on CMMI Activities & Productivity; Other CMMI News

On April 25, the GAO released a report on the progress and results of 37 CMMI models.   GAO's bottom line was that of 37 plot projects, just 6 were shown to have successfully reduced spending (while maintaining or improving quality). Even fewer (2) were expanded so far.  $5.6B has been spent since the creation of CMMI by the Affordable Care Act in 2010.
  • The GAO report is online here (54pp).
  • Trade press at Advisory Board here, Healthcare Informatics here.
  • More trade press at AJMC here and  RevCycleIntelliegence here.
This blog wrote about the GAO report on CMMI Medicaid pilots in February 2018 here.   (GAO found lack of rigor in reporting.)  

Other CMMI Recent News

Reboot & Comment
CMS/CMMI launched a "pause and reboot" project in October 2017; and a few weeks ago in April 2018 released public comments and some ideas for moving forward such as primary care direct contracting (here).

CMMI Request for Information on Direct Contracting Primary Care
Find more info about this here.  Comments accepted til May 25.

$800M Budget Cut
In May 2018, OMB proposes to cut $800M from the CMMI budget. here.  CMMI has had a ten year budget to 2019, with several billion unspent and without a spending plan, so this is more a clawback of stored funds than a cutback in programming.

New Head Adam Boehler
The Obama era head of CMMI stepped down in Summer 2017; finally in April 2018 Adam Boehler was officially named the new CMMI director.  Here.  (Boehler's name had circulated in this context since December.)   Boehler founded Landmark Health, a novel venture funded delivery system for the chronically ill (more care at home) that aimed to support Medicare Advantage and other health plans.

Brain Drain
A March 2018 article in Politico discussed "brain drain" at CMMI, here.

Rigor at CMMI? Or Not?A May 2018 article in NEJM decries the shift from randomized trials to voluntary demos at CMMI, here.   I would add that since CMMI must by statute demonstrate its programs save money and raise quality, if they are not rigorous, CMMI may be shooting itself in the foot at evaluation time.

Slow Start at Diabetes Prevention Program
This is the CMMI funded pilot-to-expansion program.  Stumbling, per an article in Kaiser Health News, April 2018.  Here.  Update in May, here.

OMB Criticizes Lack of Progress and Impact at CMMI

In June 2018, OMB head Joseph Grogan put CMMI in his crosshairs for a round of criticisms.  These are summarized in an August 2018 blog by Thomas Sullivan at the Policy & Medicine blog.  See multiple links - here.


More generally on alternate payment models -

For a March 2017 JAMA article on value based purchasing ("Time for a reboot?") by Jha, here.

For a May 2018 editorial on measuring bundled payment programs in Annals of Internal Medicine by Provonost at Johns Hopkins, see here (trade press here.)    For a NEJM article on the poor performance of "performance measures," MacLean et al., here

For a comparable to director Boehler's prior business Landmark Health, see perhaps the business Hometeam (here, here).