Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation (2025)
Chapter: 2 Expert Panel Review Highlights
2
EXPERT PANEL REVIEW HIGHLIGHTS
Taking the background and context provided in the previous section, the Expert Panel considered that the dominance of fee-for-service payment arrangements within the U.S. health and health care system has negatively impacted outcomes, cost, and value. This structure has ultimately impeded the achievement of a health and health care system that delivers effective, efficient, and equitable results. As such, it is clear that the planning, delivery, payment, and accountability of the health system must change. The panel suggested that future Center for Medicare & Medicaid Innovation (CMMI) efforts account for the needs of individuals and families and the increasing knowledge around the social drivers of health and their impact on health and well-being. They also suggested that CMMI focus on creating more comprehensive, integrated, and aligned services that centered on beneficiary needs. Below is a summary of the suggested anchor commitments for CMMI to advance progress. For additional context and content from the original version of this synopsis, see Appendix A.
To expedite the transformations required, the panel suggested that CMMI enhance its role as a catalyst, adding to its current role of principal model builder and facilitator. These facilitation efforts could include system-wide alignment in aims and strategies, the use of Medicare and Centers for Medicare & Medicaid Services–wide levers for changes needed and promoting the creation and adoption of synergistic policies both within the U.S. Department of Health and Human Services and throughout the Biden–Harris administration.
The Expert Panel included a variety of suggestions that would help CMMI enact its broad role and commitment to being a strate-
gic change agent. First, the Review urged CMMI to express a clear intent to leverage the purchasing power of Medicare and Medicaid to catalyze comprehensive all-payer changes. Second, it encouraged CMMI to introduce expanded primary care and prevention, introducing more population health– and primary care–focused models promoting care value over care volume and exploring the possibility of continued experimentation with mandatory specialty care bundles and episode models. Third, the Review highlighted the need to include models providing support and services for mental health, behavioral health, and social services, including screening and navigation strategies, community-based risk adjustment instruments, and business–community partnerships. Fourth, the Review encouraged action on data collection and use, namely an annual beneficiary assessment measuring care quality that is aligned with patient goals and the immediate requirement that all models and demonstrations require collection and reporting of core data on race, ethnicity, and related key social drivers of health. Fifth, the Expert Panel urged CMMI to use new resources and deliverables to help states build the necessary infrastructure for advanced care models. Finally, the Expert Panel urged CMMI to work with stakeholders in developing a comprehensive roadmap that catalyzes the achievement of the whole person and population health–oriented health financing. The roadmap could include a transparent and measurable set of goals, benchmarks, and timetables. The Expert Panel synthesized the areas described above into five anchor commitments listed in Box 1. These commitments ultimately informed CMMI’s organization and structuring of its strategic plan and priorities.
BOX 1
Expert Panel Anchor Commitments
The following anchor commitments were listed as priorities in the 2021 Expert Panel Review, which can be accessed at https://nam.edu/wp-content/uploads/2021/07/CMMI_Expert-Panel-Overview_2021_5.19-Final.pdf. They have been summarized for the purposes of the highlights.
- Beneficiary as the north star: Incorporate the social determinants of health, equity, match of services with patient goals, workforce benefits, and returns to families and communities as part of the development, deployment, and evaluation of CMMI programs and policies.
- Equity in every policy: Construct policies, programs, and demonstrations that explicitly invest and promote equity that is implemented and measured across race, ethnicity, socioeconomic status, disability status, and the social drivers of health.
- Community and social drivers of health fully engaged: Explore approaches to implementing and investing in universal screening for beneficiaries for social drivers of health, navigation to community services, standard social services fee schedules, and community risk-adjustment quotients. These approaches would be targeted and measured specifically to achieve whole-person population health.
- Payments integrated and aligned: Develop a roadmap to adopt all-payer population health models with two-sided risk, mandatory specialty care bundles, and episode models. The roadmap would include guidance to facilitate the transition to shared-risk and savings, also a streamlined assessment strategy with several core metrics, and incorporate learnings from the Health Care Payment Learning and Action Network.
- Targets and measures: Create a timetable for developing targets, piloting a set of core measures expected for every beneficiary, and, ultimately, adopting a system-wide core set of assessment measures.
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