Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation (2025)
Chapter: 1 Introduction and Initiative Background
1
INTRODUCTION AND INITIATIVE BACKGROUND
The Center for Medicare & Medicaid Innovation (CMMI) was established as a key provision of the Affordable Care Act to develop, test, and disseminate care and payment models to enhance health care quality and reduce spending. A decade later, CMMI is faced with important decisions. Despite learning considerably from more than 50 alternative payment models, there is a recognition that CMMI needed to fashion a “stronger and more sustainable path forward” (The White House, 2021). This recognition has also been further highlighted by a rapidly shifting national landscape, as well as priorities for health driven by a new federal administration, the COVID-19 pandemic, and the nation’s reckoning with racism, social justice, and health inequities.
CMMI’s new leadership has therefore expressed a need to evaluate, learn, and build upon the overall impact and utility of its portfolio of efforts and models still in the pursuit of delivering improved care, enhanced health outcomes, and reduced costs. Given the vast array of stakeholders and constituents impacted and involved in CMMI’s efforts along with the breadth and depth of payment, equity, and value-related issues in the health and health care landscape, the National Academy of Medicine (NAM) collaborated with CMMI to help inform CMMI’s future strategy and approaches.
Under the two-phase Catalyzing Innovative Health Transformation initiative, the work has sought the collective wisdom of the health and health care field. In Phase 1, an NAM-convened Expert Panel undertook a broad review of priority opportunities for CMMI to catalyze progress toward high-value, high-quality health care with enhanced effectiveness and efficiency in improving individual and population health. The Expert Panel Re-
view, published by NAM, identified anchor commitments and action steps for CMMI to solidify their role as a catalyst for change. These broad areas included:
- Centering beneficiaries as the north star of CMMI efforts,
- Incorporating equity in every policy,
- Engaging community and social drivers of health,
- Integrating and aligning payments, and
- Creating targets, timelines, and measures.
After publishing the Expert Panel Review, the Expert Panel was converted into a Steering Committee to guide NAM’s Phase 2 work activity: convening a two-part discussion series to consider and provide advice on the key insights, opportunities, and barriers involved in (1) aligning the strategies of multiple payers to achieve value-based care, and (2) collecting the information and data necessary to use payment policy to advance equity. Through a combination of individual presentations and open discussions, the discussion series engaged a range of field leaders and experts to describe the landscape of challenges and opportunities, highlight multi-stakeholder perspectives and examples of progress, and identify concrete steps to achieve health system preparedness, effectiveness, efficiency, equity, and beneficiary experience.
SPECIAL PUBLICATION STRUCTURE
This Special Publication is structured to provide an overview of the findings from each project phase. In Chapter 2, an abbreviated summary of the Phase 1 Expert Panel Review is provided along with the primary anchor commitments they urged CMMI to focus on in its renewed strategic plan. In Chapters 3 and 4, the insights and findings of the NAM-convened discussions on Multi-Payer Alignment on Value-Based Care and Collecting Data to Support Equity in Payment Policy are presented. These highlights are intended to succinctly emphasize and underscore the key discussion themes and their relation to CMMI’s continued efforts.
Following these highlights, Chapter 5 presents a synthesized version of the key high-level priority actions as well as key im-
plementation considerations, with six elements identified as key component processes in CMMI’s approach to advancing multi-payer alignment and data collection to support health equity:
- signaling,
- mapping,
- measuring,
- modeling,
- partnering, and
- demonstrating.
These suggested actions aim to ensure CMMI augments and enhances its capability to impact, engage, and catalyze the health and health care field to transform. Additionally, these elements are both aligned with and necessary to the achievement of the five Innovation Center Strategic Objectives outlined in the October 2021 Innovation Center Strategy Refresh, namely:
- drive accountable care,
- advance health equity,
- support care innovations,
- improve access by improving affordability, and
- partner to achieve system transformation (CMMI, 2021).
Finally, Chapter 6 underscores compelling action steps for CMMI to incorporate the initiative’s learnings as it embarks on implementing its strategic plan. To provide further clarity and context on the initiative, a detailed Appendixes section highlights the published versions of the Expert Panel Review and two discussion proceedings on Multi-Payer Alignment on Value-Based Care and Collecting Data to Ensure Equity in Payment Policy. Additionally, this section includes contextual case studies, meeting agendas, and a list of invited participants to recognize the collective multi-stakeholder effort summoned from this initiative.
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