AMA, CMS Leaders Signal New Era of Cooperation

A joint appearance by leaders from the Centers for Medicare & Medicaid Services and the American Medical Association may signal an important cultural shift in how the two organizations work together over the next few years.

When leaders from the AMA and CMS speak, healthcare leaders listen (usually it's to find out what new regulation CMS is rolling out and what the AMA plans to do about it). But typically the two organizations do not speak together—physicians and hospitals are usually cast as the long-suffering cross bearers of CMS red tape.

That dynamic may be changing.

On Monday, CMS Acting Administrator Andy Slavitt and AMA CEO and EVP, Jim Madara, MD, appeared together at J.P. Morgan's annual Health Care Conference in San Francisco. During their individual remarks and the 20-minute question and answer session that followed, both Slavitt and Madara said they were committed to work together.

"The AMA and CMS share a motivation to empower physicians to deliver higher value care with reduced regulatory burden that frees resources to be put toward patient use," Madara said.

Slavitt recognized the frustration physicians voiced last year about what seemed like a mountain of new regulations and rules. "We have to get the hearts and minds of physicians back," he said.

Slavitt also announced—to the delight of CIOs and physicians everywhere—that meaningful use is on its way out. He noted that CMS has been working with the AMA to replace it with what Madara called "a more aggregated program."

"Physicians are motivated by patient care and things they believe in," Madara said. "If they're asked to do box-checking on process measures … it really deteriorates the relationship and the system between the physician community and the regulators."

The transition away from fee-for-service payments is on the horizon for CMS. The Department of Health and Human Services announced in 2015 that it is aiming to tie nearly all of its Medicare reimbursement to value and/or quality by 2018. According to Madara, leaders at various physician organizations are aware of this massive change in payment structure, but average physicians are not.

"Rolling this out is probably not the way to go," Madara said. He believes it's up to the AMA to develop a tool that physicians can use to direct patients to the most appropriate care. "The AMA needs to do that."

AMA's Tech Venture
The tool Madara described may be one of the products the AMA's new startup, Health2047, is working on now. The for-profit, C-corporation, is based in San Francisco, and is meant to connect technological innovation with input from physicians to solve practical problems. The AMA is a founding partner of Health2047 and has invested $15 million so far.

Madara said he expects Health2047 to be a "crown jewel" for AMA. "We think having a direct bridge between this database, between content experts, between the physician community, and the tech resources of Silicon Valley [that] will—should—permit a more targeted, optimized, coordinated and rapid-cycle production of solutions."
               
Initially, Madara said, Health2047 will focus on three business tracks:

1. Partnerships with emerging or existing products
2. Co-development an emerging growth company to optimize existing products
3. Solutions that are a product of the AMA and others

He also said teams with input from engineers and physicians will be "rapid prototyping," products.

CMS praises ACOs, reduces enrollment periods
In addition to bidding MU goodbye, Slavitt also said CMS would reduce the number of special enrollment periods consumers have used to sign up for health insurance through one of the marketplaces. When pressed by the moderator to name a number, he deferred, but hinted it may just be one.

"We will keep watching this market," Slavitt said, noting that consumers' best chance to sign up for health insurance is within the next few weeks (the deadline is February 15), "unless there is a life event."

Health insurance plans participating in the marketplaces are also going to get some risk adjustment relief. Slavitt said that CMS will give early estimates of risk adjustment calculations to plans. CMS is hosting a conference to discuss the risk adjustment methodology with health plans on March 25th. The combination of reducing special enrollment periods and improving the timeliness of risk calculations is a signal that marketplaces are moving away from the startup stage.

The CMS chief also praised the increase in healthcare organizations participating in the new ACO model, which he termed "NextGen." The Pioneer ACO model, he said, was a training tool. Slavitt is confident that the ACO model is a money-saver, citing that 85% of Pioneer ACOs' quality measures improved. With the addition of 21 NextGen ACOs, he said there are now 475 ACOs; 64 are full risk ACOs. That number is up from 19 in 2015.

Slavitt wants to expand the ACO model to primary care. "We have to be able to make sure that comprehensive primary care works," he said. After that, the next priority is moving bundled payment models beyond surgeries.

Madara's comments, as expected, focused on physicians as key stakeholders who can make or break healthcare transformation, but Slavitt made a pointed effort to credit physicians, too.

"Physicians are drivers," Slavitt said. "Our role is much more minor."