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Shaking up Medicare at CMS (Guest: Adam Boehler)

May 23, 2019

Adam Boehler, a Trump administration appointee who runs the Center for Medicare and Medicaid Services' (CMS) Innovation Center, details a new voluntary payment model that moves Medicare primary care payments away from fee-for-service

CMS' Innovation Center under the direction of Adam Boehler has created a two-pronged strategy to meet Health and Human Services Secretary Alex Azar's desire to move healthcare in the U.S. toward one that places a premium on health outcomes and quality of care.

With that in mind, Boehler's team has developed a voluntary payment model where small, primary care practices will receive penalties or bonuses for keeping their patients healthier and requiring fewer doctors visits. The second model targets larger practices and health care systems that would agree to assume a portion of the risk for the cost of primary care but could end up lucrative for providers.

Boehler says the goal is shift the culture away from a fee-for-service model (which is overwhelming to doctors and shows little sign it keeps patients healthier) to one that rewards providers for healthier primary care patients. Boehler also explains how they approached the problem in an unconventional, market-based way: by looking at data that proved healthier outcomes would lower the cost of service, and not the other way around. 
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Sarah Lee is a policy advisor for health care and a host of Heartland's Health Care News podcast.