Health Policy$ense

Patrick Conway at LDI to talk about CMS delivery reform efforts

This Friday LDI is hosting Dr. Patrick Conway, Chief Medical Officer, Acting Principal Deputy Administrator and Deputy Administrator for Innovation and Quality at the Centers for Medicare and Medicaid Services (CMS). He’ll be delivering the Samuel P. Martin, III Memorial Lecture.

Dr. Conway will focus on delivery system reform in the context of CMS’s recent efforts in payment innovation and quality improvement. The new Next Generation Accountable Care Organization (ACO) model builds on their previous experience with the Pioneer ACO Model and the Medicare Shared Savings Program. Dr. Conway has written about it here.

The Next Generation model allows providers to take on greater financial risk – and earn higher rewards – than under the current Pioneer and Shared Savings programs. Patients will have more choice in whether to join an ACO and some will enjoy reduced cost-sharing for some services. Furthermore, providers can give beneficiaries small financial incentives to seek care within the ACO network. CMS expects to have 15-20 ACOs enrolled in the program in its first two years.

However, some critics point out that benchmarks will incorporate regional projections of cost growth in addition to historical trends. This methodology would seem unfair to providers who already deliver efficient care. Other providers have stated intentions to bypass the new program and focus on capitation-based or full-risk contracts with private insurers. We’ll be interested to see how Dr. Conway addresses these points.

Dr. Conway, in addition to his official duties at CMS, is a frequent contributor to national health policy debates. While he has written papers on high-profile CMS initiatives such as value-based purchasing and improved quality measurement, he has also written on topics such as the impact of open access to health care data, how to engage physician professionalism for quality improvement, how to collaborate with private insurers on payment reform, and the importance of designing health systems to care for patients over their life spans.

We will return next week to share more details from Dr. Conway’s presentation and the policy context surrounding it. Watch this space…