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CMS innovation center may ramp up data exchange plans


ORLANDO, Fla.—The CMS may use its innovation center to push early adoption of newly proposed transparency and data-blocking rules.

While there are many ways to encourage transparency, HHS Deputy Administrator Adam Boehler said the center’s models could “drive that sooner” with their advanced models.

“Where you eventually want to get here is relatively simple: You want patients and their delegates to get free access to electronic, easy to use information within 24 hours,” Boehler, who’s also director of the Center for Medicare and Medicaid Innovation, said during a news briefing Wednesday at HIMSS19.

Those proposals could start coming out of the CMMI in the next few months, he said, adding that the approach could be staggered across differing experiments.

In his dual roles—heading CMMI and deputy administrator—Boehler has a comprehensive view of how the department can take on the cost problem. He noted that HHS has been studying kidney care, which could be addressed in CMMI or by looking at how the Health Resources and Services Administration impacts organ transplant.

During the wide-ranging briefing, which covered everything from artificial intelligence to risk-based payment models, Boehler honed in on two overarching themes: releasing patient data and changing incentives.

“Those two things when combined are very significant,” he said. “Until you’re able to introduce incentives to empower patients, to let patients share in some of the value of their decisions, I don’t know that you’ll see a dramatic impact from transparency in its own right. I want to be conscious of that, and we are thinking a lot about how to address that.”

Boehler said provider incentives need to be aligned correctly, acknowledging that some provider groups are not ready to embrace the CMS’ push for taking on great risk. Every provider wanting to be involved in a value-based payment model should have that opportunity, he said. That could come via more outcomes-based reimbursement. Value doesn’t have to equate to financial risk, he added.

Boehler also sees technology being able to play a vital role in rooting out cost. The CMMI in the coming months is expected to launch an AI challenge alongside the American Academy of Family Physicians.

The goal, he said, is to be on the “edge of redefining quality.”