Letter from Payers to CMS

In May, CMS’s Center for Medicare & Medicaid Innovation (the Innovation Center) held its annual Comprehensive Primary Care (CPC) initiative conference in Baltimore, Maryland. About 400 people attended the conference, the focus of which was the recently announced Comprehensive Primary Care Plus (CPC+) and future directions.

As it did last year, the Fund convened two additional meetings at the time of the CPC conference. One was a meeting of conveners of current regional CPC projects. The other was a meeting of public and private payers, who are currently participating in CPC. Based on their experience, the group identified a set of themes that they wanted to have addressed at a leadership level at CMS. The group asked the Fund to write a letter, on their behalf, to CMS Acting Administrator Andrew Slavitt, outlining several issues.

“This is an example of the Milbank Memorial Fund’s successful shepherding of a collaborative activity,” says Lisa Dulsky Watkins, director of the Fund’s Multi-State Collaborative. “Bringing people together in the same room sets the stage for pinpointing salient issues and engaging in creative problem-solving.”

The themes of the letter include the following:

1. Multi payer efforts in CPC+ must be supported at the market level with adequate resources, clear expectations, and with unequivocal CMS engagement as a payer.
2. As the largest payer in the country, Medicare can articulate a clearer delivery system vision, and take more responsibility for ensuring that its innovations complement rather than conflict with one another.
3. Self-insured companies are not participating in multi payer efforts in numbers commensurate with their market presence. CMS can catalyze their engagement.
4. The provider selection process in CPC+ and the role of payers in that process can be clarified.
5. There needs to be integration and coordination of payers in each market with the practice transformation efforts of Regional Learning Faculty (RLF) in CPC+ and a greater emphasis on total costs of care measurement in reporting and in practice milestones.