The next chief of the CMS' idea lab will enter the scene just as early results emerge from the young agency's first efforts. Those returns will be closely scrutinized for clues to solving the nation's toughest health policy challenges, as well as picked apart for political gain.
But the results are not yet in, which carries its own political risks. Indeed, the CMS Innovation Center continues to struggle with the arduous and tense work of how to run programs considered among some of the most ambitious and least understood initiatives set in motion by the Patient Protection and Affordable Care Act.
“I don't envy your job,” Sen. Orrin Hatch (R-Utah) told Dr. Richard Gilfillan, the center's director, at a March hearing of the Senate Finance Committee. Gilfillan plans to walk away from it this month.
The opportunities and headaches will soon fall to CMS Chief Medical Officer Dr. Patrick Conway, at least temporarily.
Hatch assessed “confusion and clear lack of focus” at the Innovation Center and questioned the number of initiatives and “high-salary” employees carrying them out. But the agency is generally viewed in the industry as a bastion of smart people doing important work.
The Affordable Care Act gives the center $10 billion over 10 years. Its experiments so far include accountable care, bundled payments, primary-care case management and grants for people and organizations with promising ideas ($895 million awarded and up to $1 billion offered in a second round).
Gilfillan's departure, announced last week by release of an internal CMS memo, was met with surprise from industry executives working closely with the Innovation Center on its widely watched test of accountable care, the Pioneer ACO model. Some said his exit would risk delays to the program, which has had a bumpy start. Any replacement will need time to learn the complex program and establish the faith Gilfillan earned, which has so far been needed to weather disagreements, they said.