Following reports that the Biden administration has selected Elizabeth Fowler, J.D., Ph.D., to run the Center for Medicare & Medicaid Innovation (CMMI), an employee directory tool from the Department of Health & Human Services (HHS) now shows that Fowler has indeed been tapped for the position.
While the federal agency has not yet made an official statement, Fowler—who was most recently with the Commonwealth Fund as executive vice president for programs—certainly appears to be the next CMMI Director. Farzad Mostashari, M.D., who previously ran a separate HHS department—the Office of the National Coordinator for Health IT (ONC)—tweeted on March 1 that he can confirm the reporting over the last several days that Fowler is the pick, pointing to the HHS directory tool himself. Shira Stein, a reporter covering HHS for Bloomberg Law, first reported on Feb. 10 that Fowler has emerged as the leading contender for the CMMI Director position.
I can now confirm @politico reporting that Liz Fowler is the new @CMSinnovates director :-)
— Farzad Mostashari (@Farzad_MD) March 1, 2021
(The HHS online directory is a fantastic tool, model for govern transparency, much used by experienced journalists) pic.twitter.com/fOi0oGfGu6
Created under the Obama administration, CMMI is charged with piloting, testing and evaluating alternative payment models—such as bundled payment models, for example—with the intent of increasing quality and efficiency, while reducing program expenditures under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
Fowler was previously a special assistant to then-President Barack Obama on healthcare and economic policy at the National Economic Council, and occupied key positions within HHS where she assisted with implementation of the Affordable Care Act (ACA). She has also served as vice president for global health policy at Johnson & Johnson, where she focused on healthcare delivery system and payment reform in the U.S., and healthcare systems and reform in emerging markets.
The Bloomberg Law report noted that CMMI has run 54 payment models over the 10 years since its inception. One of the key recent points of contention has been how much money the center’s models have saved, and if more of them should be mandatory for providers, with the idea to propel forward value-based payment programs. Last fall, the Medical Group Management Association (MGMA) publicly took issue with then-CMS Administrator Seema Verma’s claim that the federal agency will implement more mandatory models in the future.
Indeed, during a virtual presentation on the state of value-based care, Verma said, according to a report in Skilled Nursing News, “The bottom line is CMMI models are losing money, generating large losses and a weak return on investment for taxpayers. The center stands in need of a course correction in model design and portfolio selection if value-based care is to advance.” Verma added, per that report, “Unfortunately, the results are deeply concerning. To date, only five models have shown statistically significant savings, and of these five, only three have been expanded on a national scale. Just a handful have seen significant improvements on quality metrics.”
She further emphasized that that mandatory participation will be vital to success. CMMI is charged with testing alternative payment models (APMs), yet according to MGMA, the agency “has been frustratingly slow in producing new options.” As such, MGMA said it “does not agree with mandating participation in payment models that are untested and lack evidentiary support.”
In a recent reactionary piece from Heather Bell, senior consultant at the Washington, D.C.-based Advisory Board, she noted, “While Fowler's appointment as CMMI chief does not immediately answer the question of [how the Biden administration will approach payment models], Fowler's past comments may shed some light on her priorities as the center reviews new and existing models. For instance, Fowler last year questioned whether the new Medicare Geographic Contracting model would adequately evaluate quality of care.”
The CMMI director position does not require the Senate's approval. Biden’s pick for HHS, Xavier Becerra, is currently going through confirmation hearings, while Chiquita Brooks-LaSure’s hearings for her CMS Administrator nomination are forthcoming.
Previous CMMI Director, Brad Smith, was the chief operating officer of Anthem’s diversified business group prior to joining the government. Smith also served as a senior advisor for value-based transformation to then-HHS Secretary Alex Azar.
