Patrick Conway, MD, Chief Medical Officer and Deputy Administrator for Innovation and Quality at the Centers for Medicare & Medicaid, recently sat down for a Q&A with Donna Shalala, President of the University of Miami, at “The Business of Health Care” conference.
“I’m CMO at CMS for 4 years,” Dr. Conway said. “Which means if I make it another year, I’ll be the longest serving Chief Medical Officer in CMS history. And at CMS it’s like dog years, so it feels more like 28.”
During the Q&A, Dr. Conway addresses:
* How the historic pace of Federal government change may lead to more innovation in Medicare payment reform from states
* Why newer provider-led and voluntary payment models might succeed where others did not
* How healthcare technology — including new disruptive technology — could improve quality and lower costs.
Shalala: What are some of the obstacles you’re running into because you have to sit at the Federal level and incentivize states and providers?
Conway: If you look at the state innovation map, for states like Texas and Florida that are not in the state innovation program, we’re looking at we partner with those states. We have a Medicare Innovation Accelerator Program that allows us to partner with states in a different framework to support their Medicare transformation. It’s about how to work with states across the board.
On the providers, it’s an interesting question. We picked up the early adopters and now we’re hitting the big middle of the curve. How do we shift providers and pick up the end of the innovation curve, if you will?
Then the last thing — I’ve been in government twice, which I wouldn’t have predicted but I love it, and you know well — is just that the pace of change in government is never as quick as I would want it or many of us would want. Whether it’s an annual rule making cycle or statutory issues that sometimes restrain our ability to innovate. I think that creates a real challenge.
Shalala: Which is one reason you want to do a lot with the states where you can put it out there or with the providers?
Conway: Yes. A few years ago the State Innovation model was very small, with a small number of states. We went from working with a handful of states to now 37 states and territories. It’s one of the models I’m most excited about.
Shalala: Because you learn things there, and the states like to copy each other?
Conway: They do. We have a learning network where they learn from each other, and it’s actually working. They’re thinking of how they spread an innovation from one state to the other.
Shalala: On this issue of cost, are you concerned, the way some people in the industry are, that if we keep slowing down the growth, that we’ll destroy the incentives to create new technology?
Conway: I’m not — because I think new technology can improve quality and lower cost.
Shalala: But we have a whole history of introducing technology and raising cost.
Conway: Yes. So let me frame it this way, and I also run coverage decisions for CMS. Technology that improves patient outcomes we should pay for, and pay for appropriately. Actually our coverage statute even explicitly says I cannot look at costs. I look at the efficacy and effectiveness of the technology.
I also think we’ll have new technology –some of which raise costs and improve outcomes, and that’s value. That’s the quality over cost value equation, as you know, and we should pay for. I think we’ll also have some disruptive technology that improves quality and lowers costs.
Bonus Question [from the audience during open discussion]:
Q: Todd Florin, MD, MBA, and Founder of room2care.com: Looking at your projections for lowering Medicare expenditures, and it just reminds me an awful lot of when the Bush Administration rolled out the SGR – which we’re now getting rid of – why will this be successful while that was such a political failure?
Conway: The primary differences are the innovation models I talked about today are voluntary, led by providers and organizations in the health system – so they’re driving the change. Everything from the accountable cares to bundles to the Comprehensive Primary Care – those are all voluntary models where providers are leading the change. We’re trying to set the right balance of setting the right large outcomes incentives without dictating how you get there. So you allow innovation, whether it’s a health system or smaller primary care practice. I can tell you because we interact with them a lot –we’re fostering a whole industry of what I’ll call health care innovators.
We’re trying not to take a top-down approach – but actually catalyzing and fostering innovation at a community and local level.
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