The Center for Medicare and Medicaid Innovation (CMMI) will implement a new, three-pronged strategic direction aimed at improving access and outcomes while reducing health care costs.

More seriously ill individuals are living longer with multiple comorbidities, a trend that has increasingly overburdened and financially strained the health care system and families across the country, according to Abe Sutton, director of CMMI and deputy administrator for the U.S. Centers for Medicare & Medicaid Services (CMS).

Costly medical treatments are pushing federal and state health care spending to excessive levels, Sutton said in a webinar on Tuesday. Innovative policy changes are needed to address the issue, he stated.

“We’ve reached a critical juncture in American health care,” Sutton said during the webinar. “Our system is facing unsustainable cost pressures. To make matters worse, Medicaid is the number one expense for most states, crowding out priorities … The Medicaid trust fund is predicted to be insolvent by 2036. But if we come together to leverage innovation and smart public policy, our approaches can change these challenges. We can address them with intention and rigor. We have a meaningful opportunity to drive systematic change and help people stay healthier longer.”

The new strategic direction focuses on three interrelated pillars

1. Promote evidence-based prevention
2. Empower people to achieve their health goals
3. Drive choice and competition

Much of today’s health care resources are spent on treating a condition rather than understanding root causes and prevention, according to Sutton. The first strategic pillar is aimed at increasing engagement with the management of chronic disease, minimizing the impact on patients and families, as well as building more clinical approaches to prevention. The next phases of CMMI models will work to provide patients with easier access to evidence-based, holistic medicine approaches, he said.

“We’re going to focus on data collection as part of this [pillar],” Sutton said. “We hope to show that Innovation Center models can prevent the onset of disease, can improve function, health status and well-being for participants, can reduce adverse events and acute-care utilization, can slow or halt disease progression, and can increase time at home and mitigate intensive, long-term care needs by addressing functional and cognitive decline.”

The second strategic pillar will address ways to provide patients and families with stronger avenues toward goal-concordant care delivery. Patients need better access to health care information, tools and support, according to Sutton.

CMMI is developing patient-facing mobile applications that will drive better data transparency and provide cost and provider performance insights. Leveraging technology and data-sharing tools will hopefully drive stronger coordinated care delivery and improve health care decision making capabilities, he said. The agency is aiming to align financial incentives and flexibility with health, potentially issuing waivers that will support more predictable cost-sharing rates for certain health care services, medications and medical devices, according to Sutton.

The third strategic pillar aligns with the Trump administration’s goals to foster an “even playing field” in health care competition “whenever possible,” Sutton said during the webinar.

A main goal is to provide patients with more health care options and incentivize more opportunities for high-quality health care innovation. This will involve engaging new health care provider types that fall outside the traditional scope of CMMI payment model participation, including value-based innovations, he indicated.

Independent, rural-based health care practices and home-based care providers fall into this realm, according to Sutton. The agency is seeking to simplify and standardize its portfolio of payment models in an effort to reduce administrative burdens related to participation, he stated.

“We often hear from providers and payers that engaging in value-based care has been overly complicated, and that administrative burden is a major barrier,” Sutton said. “For this reason, the Innovation Center will seek to simplify and standardize our portfolio of models where possible. We will look for ways to create more predictability in our work, such as standardized quality measures, improved and simplified benchmarking that does not present opportunities for arbitrage, and provide free mid-model changes due to upfront design considerations.”

Sutton also indicated that CMS could be taking another look at state Certificate of Needs laws.

“We promote site neutrality to ensure current delivery system incentives, [do] not impede choice, along with supporting changes at the state level to strengthen competition, such as confronting uncompetitive certificate of need laws,” Sutton said during the webinar.

The new strategic focus will allow CMMI to test payment models designed to reduce costs and build pathways that scale into more permanent Medicare, Medicaid and Children’s Health Insurance Program (CHIP) programs, according to Sutton. Future models will expand the use of advanced shared savings and prospective payments to support independent provider participation, he stated.

The agency plans to update existing Medicare models and design new payment models, regulatory flexibility that enhance beneficiary incentives. CMMI intends to expand testing improvements in the Medicare Advantage and Medicaid reimbursement landscape. The agency is working with multi-payer approaches at the state level to transform rural- and value-based care delivery, Sutton said.

Seniors, individuals with disabilities and underprivileged youths represent some of the most vulnerable patient populations in need of stronger health care support, said CMS Administrator Dr. Mehmet Oz.

About 6-in-10 Americans have at least one chronic disease, while 4-in-10 individuals have two or more chronic diseases, reported the U.S. Centers for Disease Control and Prevention (CDC).

Examining the “tough realities” around serious illness and forces fueling rising health care expenditures will hopefully drive innovative, meaningful change for these patient populations, Oz stated.

“[We are] going to provide Americans access to excellent care, especially those who need our help the most — disadvantaged youth, those with disabilities and our seniors,” Oz said during the CMS webinar. “We have a generational opportunity to give people power over their health and to save our health care system from costs that are rising faster than our economy. We’re going to deliver better outcomes, and we’re going to make America healthy again. It’s time to roll up your sleeves and get to work.”