The House Energy & Commerce Committee held a Health Subcommittee hearing on Thursday, June 13, regarding the Centers for Medicare & Medicaid Innovation (CMMI).

CMMI, also known as the Centers for Medicare & Medicaid Services Innovation Center, was established by the Affordable Care Act in 2010 to design and test innovative payment and service delivery models in health care in order to address increasing costs, quality of care, and inefficient spending.

The Medicare Access and CHIP Reauthorization Act of 2015 established the Quality Payment Program, which consists of the Merit-Based Incentive Payment System and Advanced Alternative Payment Models (APMs). Both value-based payment models were intended to measure and reward quality care, and CMMI has been tasked with overseeing the development and management of APMs.

In his opening statement, Subcommittee Chair Rep. Brett Guthrie (R-Ky.) said, “The Congressional Budget Office (CBO) originally projected that CMMI would not just offset the cost of running pilot programs but drive significant long-term savings across the health care system that unfortunately has not come close to materializing.” According to a CBO analysis from September 2023, CMMI increased federal spending by $5.4 billion, with a projected increase in federal spending of $1.3 billion between 2021 and 2030.

Elizabeth Fowler, Ph.D., J.D., deputy administrator and director of CMMI, testified before the subcommittee to deliver an update on the transition to value-based care. Throughout her testimony, including her written testimony, Fowler explained that CMMI is committed to improving quality of patient care and achieving cost savings, with quality being the primary focus.

Subcommittee members expressed concern throughout the hearing about whether CMMI is fulfilling its statutory obligations to achieve cost savings. When Subcommittee Ranking Member Rep. Anna Eshoo (D-Calif.) asked why CMMI has not generated savings, Fowler said the voluntary nature of the models and the unpredictability of innovation render it difficult to achieve the desired savings results that were intended when the models were first implemented.

In her written testimony, Fowler wrote, “We are committed to continuing to work with patients and families, providers, payers, states, and Congress to drive innovation that addresses the central challenges facing people in the health care system and transform patient care, outcomes, and experience.”



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