Health and Human Services Building, Washington, D.C.
“Public Expects Gridlock” is the headline to a summary of survey findings about what voters expect out of Washington post-midterm elections. The Democrats control the House, Republicans control the Senate and not much of anything will get done inside the Beltway for the next two years. But it seems like no one told that to the team over at the Center for Medicare and Medicaid Innovation (CMMI).
After a slow couple of years and recent leadership changes, the Innovation Center has been rolling out new delivery and payment models and hinting at more models coming down the pike. Prior to the elections, CMMI introduced new models aimed at addressing behavioral health needs for children and opioid use disorder in pregnant and postpartum women. And in recent public remarks, HHS Secretary Alex Azar and CMMI Director Adam Boehler have previewed a mandatory oncology care model, hinted at a new primary care models with increased risk and discussed a desire to pursue direct-contracting models.
Perhaps most notable however, is the announcement of a forthcoming model that would allow Medicaid to pay directly for social services that impact health outcomes, such as housing and food. Previously, Medicaid dollars have been used to pay for some ancillary services, such as housing supports and there have been efforts to screen Medicaid beneficiaries for social needs and refer them to social service providers, but paying directly for food or housing would be a major policy change. There is mounting evidence that addressing social and economic factors, such as poverty, education, housing and food insecurity and racial discrimination, are critical to improving health outcomes. Social factors account for nearly a third of deaths in the US every year and stress, low incomes, and low education levels are directly associated with poorer health outcomes or premature death. We believe that the federal government can do more to promote approaches to health that address the social barriers preventing individuals and communities from achieving health and well-being, which is why last year, we asked CMMI to advance a model like the one they are developing.
This increase in activity is promising and exciting. We’ve long held that transforming the health system to work better for patients should be a bipartisan issue. But that doesn’t mean we aren’t still cautious. We’ve seen this administration use language about the social determinants of health to justify harmful Medicaid work requirements that lead to coverage losses. And in direct contrast to proposals to expand coverage for social determinants in Medicaid, the administration has signaled it’s considering allowing states to drop coverage for important services, such as non-emergency medical transportation. More broadly, the way the administration has viewed “consumer engagement” puts an emphasis on patients as informed shoppers- a model that doesn’t work for many rural and underserved patients who might have little choice in which providers they can go to, nor for people with the most complex needs, who benefit the most from coordinated, comprehensive care.
So we’ll keep our eye on the whole picture. We’ll continue to push for greater consumer engagement while pushing back against “consumerist” strategies that restrict access to care. We’ll look for innovative ways to address the social determinants of health, while fighting against cuts to coverage that are disguised as economic empowerment. And we’ll push for new models that advance person-centered care while working to preserve important access and protections for patients with the most complex health needs. As any frustrated sports fan can tell you, you won’t get very far with only a good offense or defense. Moving towards a high quality, person-centered health system is going to require playing on both sides of the ball.