Health Policy$ense

LDI Senior Fellows Meet with CMS Administrator Seema Verma

Bundled payment, consolidation, ACA exchanges discussed

Meeting with CMS Administrator Seema Verma are Scott Harrington, PhD, Wharton Professor of Health Care Management; Amol Navathe, MD, PhD, Assistant Professor of Health Policy and Medicine; Mark Pauly, PhD, Professor of Health Care Management; and Lawton R. Burns, PhD. Professor of Health Care Management. Not shown: Ralph Muller, CEO of the University of Pennsylvania Health System.

Bridging the gap between researchers and policymakers is a lot easier when everyone sits around the same table. After delivering a keynote at the recent Wharton Health Care Business conference, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sat down with a group of LDI Senior Fellows to discuss current federal initiatives, understand relevant research and research gaps, and exchange ideas.

Organized by Lawton R. Burns of Wharton, the meeting covered a lot of ground, touching on 10,000-foot level topics such as:

  • The limited reach, thus far, of alternative payment models (APMs). Despite great attention paid to APMs, only a minority of physicians are involved in them. The rhetoric is far ahead of the reality.
  • The growing consolidation in the health care industry, and its effect on costs. It is likely that consolidation has something to do with the limited reach of APMs.
  • Bundled payments, including the surge in participation in the new BPCI-Advanced program. Evidence suggests that results are different for medical versus surgical bundled payment conditions, and that the design of the program may have to change.
  • Financing and performance of the Affordable Care Act exchanges. The Section 1332 waiver process may need to evolve to meet current challenges.
  • Coordination of care within an academic medical center’s provider network.

We are grateful for the time to discuss these issues during Administrator Verma’s visit. LDI looks forward to further interaction with the Administrator and her staff and to sharing the expertise of a broader range of LDI fellows.