Boehler: CMMI eyes primary care fee-for-service redesign

The Center for Medicare and Medicaid Innovation is considering new models of healthcare delivery designed to move the industry to value-based care, starting with primary care.

Adam Boehler, CMS deputy administrator and director of CMMI, told an audience at last week’s HIMSS19 conference in Orlando that the agency wants to “blow up” fee-for-service.

“We’re going to do everything we can to change that system,” said Boehler, who joined CMS last April. “We can’t support a system that’s based on volume—because you get what you pay for. That is a goal underlying everything.”

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CMMI, which was created by the Affordable Care Act to test innovative payment and service delivery models leveraging health IT, is looking first at transforming primary care, which Boehler describes as the “backbone” of America’s healthcare system.

“The nice thing about primary care is it’s a small amount of spend, but it controls so much more,” observed Boehler. “And, so, it’s something that you can easily invest in and that can respond very well to outcomes.”

He noted that many physician groups in Medicare Advantage are “taking full accountability,” and CMMI is looking to give physician groups “that are ready to take full accountability” in traditional Medicare fee-for-service the opportunity to also improve quality and drive down healthcare costs.

“What we’re looking to do—to start—is a whole primary care redesign,” Boehler added.