Tag: CMS Administrator Seema Verma

HHS Aims To Deliver Value-Based Transformation In Primary Care

U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announce the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system. The CMS Primary Cares Initiative will aim to reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing overall healthcare costs, HHS said in a statement.

Image result for HHS Secretary Alex Azar
Alex Azar

“For years, policymakers have talked about building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center. These new models represent the biggest step ever taken toward that vision,” said HHS Secretary Alex Azar. “Building on the experience of previous models and ideas of past administrations, these models will test out paying for health and outcomes rather than procedures on a much larger scale than ever before. These models can serve as an inflection point for value-based transformation of our healthcare system, and American patients and providers will be the first ones to benefit.”

Empirical evidence shows that strengthening primary care is associated with higher quality, better outcomes, and lower costs within and across major population subgroups. Despite this evidence, primary care spending accounts for a small portion of total cost of care, and is even lower for patients with complex, chronic conditions, HHS said.

CMS’s experience with innovative models, programs and demonstrations to date have shown that when incentives for primary care clinicians are aligned to reward the provision of high-value care, the quality and cost effectiveness of patient care improves, the organization cited.

CMS Administrator - Seema Verma
Seema Verma

“As we seek to unleash innovation in our health care system, we recognize that the road to value must have as many lanes as possible,” said CMS Administrator Seema Verma. “Our Primary Cares Initiative is designed to give clinicians different options that advance our goal to deliver better care at a lower cost while allowing clinicians to focus on what they do best: treating patients.”

Administered through the CMS Innovation Center, the CMS Primary Cares Initiative will provide primary care practices and other providers with five new payment model options under two paths:

Primary Care First and Direct Contracting.

The five payment model options are:

  1. Primary Care First (PCF)
  2. Primary Care First – High Need Populations
  3. Direct Contracting – Global
  4. Direct Contracting – Professional
  5. Direct Contracting – Geographic

The Primary Care First (PCF) payment model options will test whether financial risk and performance based payments that reward primary care practitioners and other clinicians for easily understood, actionable outcomes will reduce total Medicare expenditures, preserve or enhance quality of care, and improve patient health outcomes. PCF will provide payment to practices through a simplified total monthly payment that allows clinicians to focus on caring for patients rather than their revenue cycle. PCF also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations (SIP).

Both models under PCF incentivize providers to reduce hospital utilization and total cost of care by potentially significantly rewarding them through performance-based payment adjustments based on their performance. These models seek to improve quality of care, specifically patients’ experiences of care and key outcome-based clinical quality measures, which may include controlling high blood pressure, managing diabetes mellitus and screening for colorectal cancer. PCF will be tested for five years and is scheduled to begin in January 2020. A second application round is also planned for participants starting in January 2021.

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AMA: Extension Needed On Comment Period To Proposed Interoperability/Info Blocking Rules

Image result for american medical association logoThe American Medical Association delivered the following comment letter to ONC National Coordinator Donald Rucker, MD and CMS Administrator Seema Verma urging a 30-day extension to the comment periods for the two proposed federal rules regarding interoperability and information blocking. The letter is posted in its entirety below:

Dear Dr. Rucker and Administrator Verma:

On behalf of the physician and medical student members of the American Medical Association (AMA), I want to express my appreciation for the detail and thought put into your proposed rules, 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program and Medicare and Medicaid Programs; Patient Protection and Affordable Care Act and the Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-facilitated Exchanges and Health Care Providers.

The 21st Century Cures Act includes many provisions that, through prudent regulation, will advance patients’ and physicians’ access to medical information. I recognize and appreciate the desire for swift rulemaking. However, such rapid change in health care policy, technology, and business practices may lead to unintended consequences for patient privacy and physician burden. Moreover, the proposed rules are interwoven, complex in nature, and include multiple detailed requests for information. To ensure that the rules are as successful as possible in meeting your goals, it is vital that stakeholders be given adequate time to provide comprehensive, thoughtful, and detailed comments. Expediency should not take precedence over deliberation as we confront a true paradigm shift in health care. I therefore urge that the comment periods for both rules be extended by at least 30 days. I appreciate your consideration and ongoing collaboration.

Thank you for considering our request. If you have any questions or care to discuss further, please feel free to reach out to Margaret Garikes, vice president of federal affairs, at 202-789-7409 or margaret.garikes@ama-assn.org.

Sincerely,

James Madara, MD

CMS Administrator Seema Verma at HIMSS19: “The Data Belongs To The Patient”

Seema Verma during her HIMSS keynote

On Feb. 12, 2019, CMS Administrator Seema Verma held a session with some members of the healthcare media (this reporter attended the session) at HIMSS19 in Orlando in which she previewed her keynote remarks at the conference. During the briefing, and later during the actual keynote, Verma provided insight into the recently released Interoperability Proposed Rule as well as spoke directly about the Center for Medicare and Medicaid Services (CMS)’ efforts for empowering American patients.

During each session, Administrator Verma highlighted specific actions her agency is taking to ensure Americans have access to their medical records in a digital format. She also profiled some of the steps for setting the stage to increase seamless flow of health information, reducing burdens on patients and providers, and fostering innovation in healthcare through the unleashing of data for researcher and care innovation.

The Administrator took a strong tone to support patient access to their health information and ownership of patient data. “One thing that I want to make very clear for the entire healthcare system is that the data belongs to the patient. It’s their data. It doesn’t belong to the provider. It doesn’t belong to the EHR company. It belongs the patient.”

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