“It takes time, but at the same time, people—at least in Congress—are going to be a little bit impatient,” Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, said at the hearing. “They want results that are quantifiable, demonstrable, that you can put your finger on and see; not just grand goals and platitudes.”
It's a lot of pressure on an office that has yet to finish hiring all of its staff. But health policy experts and Baucus, who championed the new agency as a way finally to bring federal healthcare spending under control, saw its $10 billion budget and power to implement its recommendations across Medicare and Medicaid as a key policy breakthrough.
“There's probably nothing more important in Medicare policy today than what is going on at CMMI,” said David Kendall, a senior fellow on health policy at Third Way, a centrist Democratic think tank.
But three years into the agency's operations and $3 billion of its budget committed to test pilot healthcare delivery and payment projects, the office has yet to produce recommendations. Its director, former Geisinger Health Plan CEO Dr. Richard Gilfillan, delivered a promise at the March 20 hearing that those insights will start emerging “within the next two years.”
“Of course, we're all eager to see the results of these models, but we need to be realistic; this change is difficult,” Gilfillan said. “Some models will work and some will not; it will take time to see the improvements we're after.”
Critics said the slow pace is a result of the office's myriad initiatives, which include pilot tests of 17 new models of care delivery and funding, and administration of 20 healthcare demonstration projects that predated the innovation center.
Sen. Orrin Hatch (R-Utah) said last week that the center suffers from “confusion and a clear lack of focus” and would achieve results quicker if it limited its energies to a few efforts, such as ACOs and bundled-payment reforms.
The pressure for results led CMMI to develop “a rapid cycle evaluation group” that will review pilots' results on a quarterly basis, and Gilfillan promised to provide those results to Congress.
The earliest data is expected from two primary-care projects: the Multi-payer Advanced Primary Care Practice demonstration and the Federally Qualified Health Center Advanced Practice Primary Care demonstration, Gilfillan said. First-year results from pioneer ACOs are expected this summer.
Karen Davis, a health policy professor at Johns Hopkins University and a longtime Washington policy leader, said the innovation center has faced challenges collecting data that's strong enough to support expanding its ideas broadly across Medicare and Medicaid. Those obstacles have included the need for large-scale pilots to provide statistically significant results—something the innovation center has tried to address by enrolling more than 50,000 providers in its initiatives.
“It's going to be messy and people are just going to have to be patient, and I know that's not a natural quality for those paying the bill or eager for solutions,” Davis said.
Here are snapshots of the Top 5 innovations happening in healthcare delivery right now: