Original Article by David Raths - Healthcare Innovations
Jon Blum, principal deputy administrator and chief operating officer, also says CMS is working to harmonize across programs in terms of quality measures, prior authorization rules, and network standards
Speaking to the NAACOS fall conference on Sept. 21, Jon Blum, principal deputy administrator and chief operating officer for the Centers for Medicare and Medicaid Services, stressed that CMS is “getting back to basics” by reiterating that the Medicare Shared Savings Program is the core engine for how it wants to expand accountable care throughout the fee-for-service Medicare program.
“During the last 6, 7, or 8 years, I think the agency has really kind of deviated from that model in thinking about new risk models,” Blum said. “They're important, but I think that we lost sight that the Medicare Shared Savings Program is the engine. Getting back to basics means that we're going to continue to use the innovation authorities to test new ways for us to pay and to set standards for how we think about the next generation of the ACO models and how we can take those learnings and feed them back into our fee-for-service shared savings program.”
He added that CMS is particularly interested in catalyzing growth for those ACOs that serve more challenged parts of the country — rural areas and large inner cities.
A more seamless system
Blum said that most people in our country will be covered by CMS programs several times during their lifetime. If they have a baby, if they lose their job, change jobs, decide to start their own business, have a disability, have a child with a disability, or turn 65, they are going to be served by CMS programs, and people come in and out of these programs often. “We see that in our data and it is imperative for us that we begin to think about CMS programs less as single silos, less as Medicare, Medicaid, and marketplace, as we think about quality measures and how we think about prior authorization rules, how we think about network standards,” he explained.
Blum said they are working hard to harmonize CMS programs because it doesn't make sense anymore for CMS to have three sets of rules or different coverage requirements, different benefit requirements, different network adequacy requirements. Just because people happen to lose their job or happen to turn age 65 doesn't mean their care system has to change. “The imperative for CMS going forward is that we have to do better and think more about how we build that more seamless system, even though we've got statutory constructs that define people's health insurance status depending on their demographic, depending on their poverty, depending on their family situation, their job situation, but for us, it means that we have to do better to really harmonize CMS programs to create that one experience.”
A closer look at Medicare Advantage
Blum also shared some thoughts about the rapid growth of the Medicare Advantage (MA) program, and said CMS will become a “tougher payer” for MA plans.
“Our teams have done a lot of work to ensure that we can move that program to be one that better support CMS values, better supports our collective values,” Blum said. He described MA as a program that is growing quickly, that is being paid quite well and has a lot of flexibilities to provide more benefits to beneficiaries.
Blum asked: “Does it make sense for us to pay more per person to go into the MA program? How do we think about that value? Despite what we hear from some, it is absolutely true, without a doubt, that for every Medicare beneficiary who leaves fee for service to go to the MA program, it costs the taxpayers more. That is a fact. But Medicare beneficiaries can get much more value for that switch in the form of lower cost sharing, lower premiums, and better benefits such as dental and vision,” he said. “So the questions that we're asking is how much should the taxpayers pay in order to get the most value? How much should we care about whether or not the benefits being promised are actually delivered to beneficiaries? We see in some markets a plethora of new benefits being offered — things not covered by the statutory Medicare program — but then we hear a lot of friction about beneficiaries not getting access to the core services they're entitled to."
CMS will be asking much tougher questions going forward, Blum stressed. "If a plan wants to provide food supports, wants to provide transportation supports, wants to provide better hearing and vision and dental, that's a good thing for our beneficiaries, so long as those plans are covering the basics, making sure beneficiaries get access to hospital care, physician care, and all the other benefits they're entitled to. You will see CMS in the future be a much tougher payer and a much tougher regulator to ensure that for every beneficiary the taxpayers pay more for, the value is there, the service is there and beneficiaries have full information for the choices that we're making.”