Monday, April 19, 2010

News from the World Healthcare Congress

Among the many announcements made at the 7th Annual World Healthcare Congress, acting director of the Center for Drug and Health Plan Choice Jonathan Blum was introduced as the new Policy Director for the Centers for Medicare and Medicaid, reporting directly to HHS Secretary Kathleen Sebillius.

In his presentation, Jonathan made several key statements:
  • On the Medicare side, CMS will take the lead in payment reform and quality improvement measures, stressing a desire to partner with State Medicaid and Private Payers to reduce cost, improve quality outcomes, and maximize available dollars.
  • His first priorities are dealing with Part D, where the "donut hole" will be closed in a ten year period.
  • CMS is also looking to contract for discounts. Changes to payments for Medicare Advantage (MA) plans will occur and have basis of payment on quality and outcomes in 2012. When plans have an increase in their quality rating and elevate outcomes, they will receive a reward of higher payments.
  • The CMS Center for Innovations has been established to open in January 2011 with funding of $10 million. They are planning on creating an Accountable Care Organization (ACO) policy for Medicare Programs, Pay for Performance Systems (PPS) for hospitals. However, bundled payment will take more time. With the Center for Innovations, CMS now has the authority to take successful demonstration projects from inception to reality without having to return to Congress for approval. For unsuccessful projects, there will still be valuable information learned.
  • Next steps for MA include streamlining the process for beneficiaries, developing best-care models (with an emphasis on coordination of care for members), and creating better quality and more competitive plans.
  • There has not been a substantial change in the number of PFFS plans leaving the market place, however, there is an all-time high of beneficiary satisfaction in their MA plans and are increasing their request of geographical areas.
  • Fraud and abuse continue to be a huge area for CMS and will continue to be addressed.
Jonathan clearly has both the credentials and contacts to be successful in his new role, and his remarks indicate that he has a firm grasp on the process to develop and implement many of the new regulations that will be addressed in the upcoming months and years.

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