The Centers for Medicare & Medicaid Services (CMS) on Tuesday outlined a new vision for its Innovation Center, signaling a commitment to prevention, equity and value-based care.
While the vision shared on Tuesday sets forth high-level goals and objectives, the overarching directive could carry future implications for home medical equipment (HME) and durable medical equipment (DME) stakeholders.
CMS, in fact, specifically gave a nod to DME when announcing the strategy refresh.
Abe Sutton – director of the Center for Medicare and Medicaid Innovation (CMMI) and CMS deputy administrator – pointed to three specific strategic pillars. Moving forward, Sutton explained in a white paper, CMS and CMMI will aim to advance policies that promote evidence-based prevention, empower people to achieve their health goals and drive competition.
“The pillars are underpinned by a foundational principle, which is to protect the federal taxpayer, in line with the Innovation Center’s statutory mandate to produce cost savings,” he wrote in the white paper. “As responsible stewards of federal taxpayers’ dollars, the Innovation Center will focus on models that show the greatest promise for generating savings and improving quality.”
The updated strategic direction is part of the Trump administration’s “Making America Healthy Again” agenda. Officials on Tuesday framed the effort as a needed evolution in the agency’s approach to address chronic disease, social drivers of health and rising care costs.
Contextually, however, the new vision is largely in line with priorities from past administrations, rather than a radical departure from what CMS and CMMI had already been doing.
“Let me start with a simple premise: Great societies protect their most vulnerable, and we’re a great people, so we’re going to do just that,” CMS Administrator Dr. Mehmet Oz said in a related Tuesday webinar. “Alongside partners like you, CMS is going to provide Americans access to excellent care, especially those who need our help – the most disadvantaged youth, those with disabilities and our seniors.”
A shift from volume to value
For HME and DME stakeholders, the CMS Innovation Center’s vision underscores an ongoing shift from fee-for-service models to value-based arrangements.
That means equipment suppliers may need to increasingly demonstrate how their services contribute to cost savings, better outcomes and patient satisfaction.
CMS officials additionally emphasized the importance of home-based care and early interventions in Tuesday’s outline.
Those are also areas where HME and DME suppliers are well positioned to contribute.
“The focus on prevention will include: primary prevention activities to avoid disease occurrence (e.g., health and nutrition counseling, tobacco cessation); secondary prevention to detect early signs of disease before symptoms (e.g., colon cancer screenings); and tertiary prevention, that is, disease management, to slow the progression of chronic disease and improve outcomes (e.g., diabetes and blood pressure control),” the white paper described.
Services and product lines that enable patients to manage their conditions at home, such as blood pressure monitors and continuous glucose monitors (CGMs), are important preventative-care tools.
The Innovation Center plans to simplify its model portfolio, reduce administrative complexity and scale successful demonstrations more quickly, officials described on Tuesday. It also aims to encourage wider adoption of value-based care across payer types, including Medicare Advantage and Medicaid managed care plans.
While CMS didn’t outline specific programs targeting HME or DME providers, it did tease a more supportive approach when it comes to granting providers access to new waivers that “give flexibility to deliver and incentivize preventive care.”
“For instance, we will explore waivers for accountable care entities that assume global risk to provide durable medical equipment … that may bypass National Coverage Determinations if they support transition to or remaining in the home,” the white paper continued. “Other examples are reduced cost-sharing for high-value or preventive services and payments to caregivers to better support those experiencing cognitive or functional decline.
