The policy website, Policy and Medicine, covers a range of interesting topics. Here, in its August 4 issue, it covers a recent House hearing about CMMI, the CMS Center for Innovation.
Policy & Medicine here:
The June 13 House web page, here:
The webpage includes links to prepared statements and embeds a full 2 hour YouTube video of the hearing, but doesn't provide a transcript. One of the stimuli for this summer's hearing was a September 2023 CBO report that CMMI hadn't saved any money - here. (And one of the saving graces for CMMI it that it's historically score as "savings" making it hard to delete, legislatively).
In addition to the readings linked - Policy & Medicine August 4, and CBO, September 2023 - I used free software called 4KDownloader to pull down an audio file of the YouTube video, then uploaded the audio file to Otter.AI for an autotranscript. I then fed the autotranscript into Chat GPT 4, asking it to play the role of a healthcare journalist attending the House hearing. The result is below.
AI Corner
Chat GPT 4o reads audio file of June 13 House hearing.
The recent House committee hearing on the CMS Center for Innovation (CMMI) was a stormy session, with Director Liz Fowler facing sharp criticism from several legislators. The session highlighted the Center's struggles to deliver on its original mandate to reduce costs while improving the quality of care.
The hearing was a significant moment for CMMI as it grappled with intense scrutiny over its performance, particularly in light of a recent Congressional Budget Office (CBO) report that criticized the agency for increasing federal spending by $5.4 billion rather than achieving the promised savings.
Criticism and Adversity:
During the hearing, several legislators were openly critical of CMMI’s performance. They pointed out that despite being established with the dual goals of lowering costs and improving care, the agency had fallen short. The CBO report served as a focal point for much of this criticism, with members expressing frustration that CMMI, instead of saving money, had actually cost the government billions.
For instance, one legislator expressed disappointment, saying, "I have a hard time believing any objective observer could look at the results thus far and describe CMMI as a success." This sentiment was echoed by others who questioned why CMMI models have not led to the anticipated savings and have instead created more financial burden.
Another key criticism centered around specific CMMI models. Legislators were particularly concerned about the Accelerated Clinical Evidence (ACE) model, which proposed slashing payments to Part B providers for therapies [drugs] approved by the FDA through the accelerated approval pathway. This move was seen as undermining the FDA’s authority and potentially stifling innovation. Legislators argued that this could harm patients who rely on these therapies, particularly those with rare diseases where treatment options are limited.
Moreover, the Cell and Gene Therapy Access Model, another initiative by CMMI, was criticized for potentially inhibiting states' ability to negotiate drug prices and utilize value-based agreements effectively. Legislators voiced concerns that this could weaken states’ bargaining power and limit access to cutting-edge treatments for patients in need.
Fowler’s Defense and Strategic Overview:
In response, Dr. Liz Fowler acknowledged the challenges faced by CMMI but defended the agency's work. She pointed out that innovation is inherently unpredictable, and while not all models have succeeded in generating savings, they have provided valuable lessons. Fowler emphasized that CMMI’s role is not just about cutting costs but also about improving the quality of care, particularly in underserved areas.
Fowler highlighted successes like the Accountable Care Organizations (ACO) model, which has demonstrated cost savings and improved care coordination. She also discussed new initiatives aimed at addressing healthcare disparities and improving outcomes in areas like dementia care, maternal health, and behavioral health.
Fowler also admitted that voluntary models had led to risk selection, where providers enter and exit based on favorable conditions, which has undermined the ability to generate consistent savings. She assured the committee that CMMI is learning from these experiences and making adjustments where necessary, including shutting down models that do not perform as expected.
A Balanced Overview:
The hearing painted a picture of an agency under pressure but also one that is pivotal to the ongoing transformation of the U.S. healthcare system. While the criticisms were fierce, the discussion also underscored the complexity of the challenges CMMI faces. The agency's efforts to shift the healthcare system towards value-based care are ambitious, and its successes in areas like ACOs should not be overlooked.
However, the CBO’s findings and the concerns raised by legislators about specific models indicate that CMMI must do more to meet its financial targets and prove that it can deliver on the promise of better care at lower costs. The path forward for CMMI will require a delicate balance between innovation and fiscal responsibility, ensuring that new models not only improve care but also achieve the cost savings that are crucial to the sustainability of Medicare and Medicaid programs.
As CMMI moves into its second decade, the stakes are high, and the outcomes of these hearings will likely shape its future direction. For healthcare policy experts, this hearing is a reminder of the complexities of healthcare reform and the ongoing challenges in achieving a more efficient and effective healthcare system.
Imagine a Congressman is introducing legislation to de fund CMMI. Provide his speech giving his justification and seeking suport (concurrence) from listeners.
Speech by Congressman [Name] on the Proposed Legislation to Defund the CMS Center for Innovation (CMMI):
"Mr. Speaker, my fellow colleagues, I rise today to introduce legislation that calls for the defunding of the CMS Center for Innovation, commonly known as CMMI. This is not a decision I take lightly, nor one that I make without thorough consideration of the facts. But the facts, as they stand, make it clear that CMMI has not lived up to its promises, and it is time we act decisively to protect taxpayer dollars and ensure that our healthcare system is both effective and sustainable.
CMMI was established under the Affordable Care Act with noble intentions: to test innovative payment and service delivery models that could improve healthcare quality while reducing costs for Medicare, Medicaid, and CHIP beneficiaries. It was given sweeping authority, a ten-year budget of $10 billion, and the hope that it would lead the charge in transforming our healthcare system.
But after more than a decade of operation, what do we have to show for it? According to a recent report from the Congressional Budget Office (CBO), instead of saving money, CMMI has increased federal spending by $5.4 billion. That's right—$5.4 billion more in costs to the American taxpayer with little to no evidence that the healthcare system is any better for it. The original promise that CMMI would generate $1.3 billion in savings in its first decade has proven to be a gross overestimation. Even more alarming, the CBO now projects that CMMI will continue to cost the government an additional $1.3 billion in the coming years.
These numbers aren't just disappointing; they are a stark indication that CMMI has failed in its mission. We were told that this agency would revolutionize healthcare by shifting the system toward value-based care, but after testing over 50 models, only a handful have produced any meaningful results. The rest have either stagnated or, worse, driven up costs.
Take, for example, the Accelerated Clinical Evidence (ACE) model, which proposed slashing payments to Part B providers for FDA-approved therapies. Not only did this model threaten to undermine the FDA's gold standard for drug approval, but it also risked limiting access to critical treatments for patients with serious conditions. Another model, the Cell and Gene Therapy Access initiative, could have restricted states' ability to negotiate drug prices effectively, ultimately harming patients who rely on these groundbreaking therapies.
We must ask ourselves: Is this the kind of 'innovation' we want to fund with billions of taxpayer dollars? Is it responsible to continue pouring money into an agency that has consistently failed to deliver on its promises? I say no.
By defunding CMMI, we are not turning our backs on healthcare innovation. On the contrary, we are taking a stand to ensure that innovation is driven by effective, results-oriented policies that truly improve care and reduce costs. We can and should encourage innovation within our healthcare system, but it must be done with accountability and transparency—qualities that CMMI has sorely lacked.
Mr. Speaker, my colleagues, the time has come to take a hard look at the value—or lack thereof—that CMMI has brought to our healthcare system. We have a duty to our constituents to spend their hard-earned dollars wisely, and continuing to fund a program that has consistently failed to meet its objectives is not a wise use of their money.
I urge you all to support this legislation to defund CMMI. Let us work together to redirect these funds toward initiatives that will genuinely improve healthcare delivery in this country—initiatives that are accountable, transparent, and effective. Thank you."
