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Editor's Corner

View from the Frontlines: CMS’ Adam Boehler’s Presentation at the HIMSS19 Public Policy Breakfast

Last week I attended the HIMSS Public Policy Breakfast and had a chance to hear Adam Boehler--CMS Deputy Administrator-- present his thoughts, priorities and goals for the CMS Innovation Center (CMMI)...

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View from the Frontlines: CMS’ Adam Boehler’s Presentation at the HIMSS19 Public Policy Breakfast

Last week I attended the HIMSS Public Policy Breakfast and had a chance to hear Adam Boehler--CMS Deputy Administrator-- present his thoughts, priorities and goals for the CMS Innovation Center (CMMI).

Having worked closely with his two predecessors, I was interested in hearing how he approached the challenges of running that organization as well as also serving as a Senior Advisor to the HHS Secretary for Value-based Transformation and Innovation. One major difference is that Boehler is not a clinician like his predecessors and brings a business focus to the position.

Although Mr. Boehler has been in his current position less than a year, he clearly articulates his two priority areas--freeing the data and fixing the incentive side of healthcare. He also described the necessary interplay between the public and private sectors, saying the former sets the table but also needs to get the rules right to incentivize the private sector to make money by doing the right thing.

Boehler described the ONC and CMS rules released last week as huge steps forward in making data more accessible, especially to patients. He also discussed the role of artificial intelligence (AI) to support providers to use data in better ways for decision-making but stressed that AI would not replace them. He gave an example of how CMS is preparing to do an AI Challenge to come up with a smaller, more effective set of metrics to improve quality.

In the incentives area, Boehler clearly wants to eliminate the fee-for-service payment system as soon as possible; a belief he shares with his predecessor, Patrick Conway. He described 4 key drivers in the incentives area:

  1. Treat patients as consumers -- patients are not active in the incentives area. While we need price transparency, we also need good quality data. Boehler felt that the real reason for the lack of interoperability is the lack of patient involvement. He feels much of this is due to an overuse of premium-based payments.
  2. Treat providers as accountable entities -- according to Boehler, in the Medicare Advantage program, full accountability has led to better quality outcomes. He wants individual doctors to become more accountable by eliminating fee-for-service and pay them a set fee with additional incentives. Create an asymmetric upside for the doctors and simplify payments.
  3. Fix prevention incentives -- He feels that incentives for disease prevention are misaligned and should be focused on preventing disease before it occurs. He stressed the importance of looking more at social factors such as housing and transportation issues.
  4. Better align payment policies to outcomes --Boehler used an example that 40% of Medicare patients enter hospital thru 911 calls and ambulances. He said that this is not necessary in many cases. Responders should treat the patient where necessary, not be forced by regulations to take them to the hospital all the time, this policy takes resources away from really severe cases.

Overall, I thought Mr. Boehler did an excellent job of clearly articulating where he feels the industry should go and I look forward to seeing how his work at both the CMS level and at HHS progresses over the next two years.

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