Dr. Meena Seshamani of CMS: ‘This is a partnership for all of us together’

The Center for Medicare proposed an overhaul of the Medicare Shared Savings Program, which is CMS’ permanent accountable care organization program, back in July. What’s behind those changes?

Back in January, I published—along with our administrator Chiquita Brooks-Lasure and Center for Medicare and Medicaid Innovation Director Liz Fowler—a vision for Medicare around several pillars: namely, advancing health equity, expanding access to coverage and care, driving innovation for high-quality, whole person care, and promoting good stewardship of the program with affordability and sustainability for future generations. The Medicare Shared Savings Program, and our value-based care programs overall, are really a key way to drive those pillars.

The shared savings program is able to encourage more coordinated care, bringing in health-related social needs issues, encouraging a more team-based approach to care, and being able to reward providers who are providing high-quality care and spending the Medicare dollar in the most effective way to drive better outcomes.

With that high-level strategic vision in mind, we have proposed several changes to the Medicare Shared Savings Program.

If these MSSP proposals are finalized, what will success look like?

At a very high level, we want to drive better care—to have improved outcomes and healthier populations with smarter spending.

We want to be able to grow participation in these models. We want to have a defined and deliberate focus on equity in these models, to really get at the myriad issues that go into someone’s health and the disparities that have existed in our society around health and healthcare. And being able to align our programs across Medicare: As a provider who was, until recently, leading a lot of these care transformation efforts, I know how important it is that we’re all rowing in the same direction, and engaging in a thoughtful way together to be able to make improvements.

Another program that’s been top of mind for Modern Healthcare readers lately is Medicare Advantage, which also falls under your purview. CMS recently accepted comments on a request for information about the program. Why did you decide to release the RFI?

We want to make sure that we continue to improve Medicare Advantage so that [it’s based] on the strategic pillars of equity, of access, of innovation, of stewardship. We are very heartened by all of the interest that we have gotten, all the comments we’ve gotten, from people with Medicare, to entrepreneurs and innovators, to plans, to providers. There are so many people involved in the Medicare Advantage program. That’s a key piece to how we’re going to be able to move forward together and continue to improve Medicare overall.

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Medicare Advantage is expected to enroll more than half of all [Medicare] beneficiaries as soon as next year. What does your office need to do to adapt to this shift?

I think what we are doing is exactly what we need to do, in that Medicare Advantage is a key part of the Medicare program. You have Parts A and B in our traditional Medicare—we talked a little bit about the value-based care models, what we’re doing there as well. Then you have Part C, Medicare Advantage, you have Part D for prescription drugs, and then you have supplemental insurance such as Medigap. All of those pieces together create the Medicare program. It is so key that through our policymaking, through our operations, we are driving all of those toward the strategic pillars that I mentioned, and doing so in partnership with everybody involved in making care happen for people who rely on our program.

“We want to be able to get ideas, gain those perspectives and experiences from the tremendously diverse ecosystem that’s caring for people.”

Reports have raised concerns about prior authorization within the Medicare Advantage program. Is there anything on the horizon to help tackle prior authorization specifically and other potential issues within the Medicare Advantage Program?

Prior authorization is one of many areas that we asked about in our request for information, where we’re interested in seeing where things are working that we want to make sure continue to work, where we can continue to innovate, continue to scale—and where there may be improvements. That goes for prior authorization as it does with innovations around health-related social needs, et cetera. That is, in part, why we put out that request for information. We want to be able to get ideas, gain those perspectives and experiences from the tremendously diverse ecosystem that’s caring for people so that we can together see where there are opportunities for improvement.

Medicare will begin negotiating prices for certain covered drugs in 2026, after Congress passed the Inflation Reduction Act earlier this summer. What’s your plan for implementing that act, and what do providers and insurers need to know about that?

We have hit the ground running on implementation. One theme that we’ve been talking about that I’d like to pick up on here again, is the importance of collaboration and engagement with everybody involved in this.

For all of you who are caring for people on the ground, who are engaged as plans with your enrollees or as providers with your patients, people will ask: “What does this mean for us? What’s in this law?” And all of you play a very important role—not only in collaborating and engaging with us as we implement the law, but also by helping to explain it to people who can benefit so that they can make the most of it. On the CMS website, we’ll have a fact sheet. We definitely plan on doing outreach.

Improving health equity is a major goal for CMS right now. What do you mean when you talk about health equity? What can providers, insurers and healthcare executives do to help you accomplish that goal?

When we talk about health equity, we mean everyone having a fair and just opportunity to attain their optimal health, regardless of their race, ethnicity, geography, language, socioeconomic status, gender identity, sexual orientation—the myriad factors that go into being able to access healthcare, and the myriad factors that impact someone’s health. That really is central to everything we do in our program: for our day-to-day operations, making sure that care is navigable, that people can understand what their options are, that they can access what they need.

This is a partnership for all of us together, from the manufacturers, to the providers, to the payers, to the patient groups, the community-based organizations, the employers and the unions—the list goes on of everybody who is involved in healthcare in our country, and everybody who’s involved in making sure people in this country stay healthy.