Execs worry Gilfillan's CMS exit will slow reform

Outgoing CMS Innovation Center chief Dr. Richard Gilfillan was praised by health system executives for his flexibility and deep knowledge of healthcare delivery. His exit plans came as a surprise, they said, and raised concerns that a leadership disruption could slow healthcare reform efforts.

His departure, scheduled for the end of the month, was announced internally by CMS Administrator Marilyn Tavenner.

Dr. Patrick Conway will work as acting director of the CMS Innovation Center while continuing to serve as CMS chief medical officer and director of the Center for Clinical Standards and Quality, the memo noted. Meanwhile, Gilfillan and Conway will work closely with Sean Cavanaugh and Tim Love—two deputy directors at the CMS Innovation Center—in the transition period.

Gilfillan's departure comes as the Innovation Center's high-profile test of accountable care organizations undergoes growing pains. The CMMI launched the first Medicare accountable care organizations, known as Pioneers, under the

healthcare reform law in January 2012. The Shared Savings Program ACOs also started in 2012.

At deadline, a CMS spokesman had not responded to questions about the reasons for Gilfillan's departure or his subsequent plans. Tavenner's memo said only that Gilfillan will “move on to new opportunities at the end of June.”

“I think that he is going to be sorely missed,” said Tricia Nguyen, chief medical officer of the Banner Health Network, one of the Pioneer organizations. “He was very collegial, collaborative and understands the complexity” of accountable care.

The 32 ACOs, known as Pioneers, raised objections this year to quality targets that must be met to earn financial incentives. Ongoing talks between Innovation Center and Pioneer officials have not yet resolved the issue and last week a deadline for Pioneers to withdraw from the program was extended until July 15.

Nguyen raised concerns that transition could create delays or alter the course of the accountable care effort. But she praised Conway, whom she met briefly during a meeting with top CMS officials. “Rick's going to be missed,” she said. “Patrick is probably the second-best choice.”

William Chin, executive medical director of HealthCare Partners, agreed that the departure could stall the program as the incoming Innovation Center director learns the job and works to build the working relationship Gilfillan already established. “His ability to communicate created a degree of trust,” said Chin, who was scheduled to speak with Gilfillan at a health technology summit. Chin said Gilfillan earned health systems' respect.

Mike Donahue, vice president of network development and ACO activities for Eastern Main Health System, another Pioneer ACO, said Gilfillan displayed the political will to adapt to unexpected challenges that arose with adoption of the largely untested payment model. “All of this is an experiment,” he said. “What you may think is going to work flawlessly doesn't always work out that way.”

An incoming leader will also assume control of the Innovation Center as its initial ACO results become public, which will create a challenge to either capitalize on early good news or respond publicly to disappointing results, said Stephen Shortell, dean of the University of California, Berkeley, School of Public Health and a professor of health policy, management and organization behavior. Shortell, who studies accountable care, is also a proponent of the payment model.

Accountable care officials praised staff of the Innovation Center and said organizational depth would help during the transition.

In her announcement, Tavenner said that during Gilfillan's tenure, the CMS Innovation Center has evolved from a “start-up center” to an organization of more than 230 people.

“Under Rick's leadership, the Innovation Center has worked closely with the CMS leadership group, colleagues across the agency, and HHS to develop a set of innovative models intended to improve outcomes for patients and reduce costs to the healthcare system,” she said. The Pioneer and Advance Payment Accountable Care Organizations, Partnership for Patients and Bundled Payments for Care Initiative are among the accomplishments the Center has achieved under Gilfillan's direction, she added.

Dr. Donald Berwick, the former head of the CMS who recruited Gilfillan to launch the Innovation Center, described Gilfillan as a “polymath,” with an extraordinary grasp of healthcare delivery, clinical medicine and healthcare finance and policy.

Gilfillan, the former chief executive of Geisinger Health Plan, assumed control of an organization with $10 billion to spend over 10 years to transform U.S. healthcare delivery. “It was a challenge,” Berwick said. “He was up to it.”

And he did so under intense scrutiny from Congress, Berwick added. “I continually admired Rick's ability to negotiate through some very, very difficult thickets.”

Berwick praised Conway, the new acting Innovation Center head, as highly experienced and wise.

“CMMI clearly made a lot of progress under Dr. Gilfillan's leadership,” Emily Brower, executive director of accountable care programs for Pioneer participant Atrius Health, said in a written statement about Gilfillan: “He came from a delivery system similar to that of the 32 Pioneers so he understood the issues that we brought forward and what it means to be truly accountable for the care of Medicare beneficiaries. He was always a good listener. This change is a loss for CMS and the Pioneer program, but the program is moving along nicely and a successor should be able to continue the forward progress.”

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