CMS Launches Revised Innovation Center MAHA Strategy

The CMS Innovation Center, formerly known as the Centers for Medicare and Medicaid Innovation or CMMI, has launched a new strategy to “Make America Healthy Again” (MAHA) and “protect federal taxpayers” as CMS continues to explore and approve alternative payment models in both Medicare and Medicaid. The strategy focuses on three (3) pillars:

  1. Promote evidence-based prevention. Prevention will be part of every model; interventions will closely monitor to ensure they are on the path to certification for expansion, contributing to a broader disease prevention, health promotion, and reduced overall costs. Under the MAHA framework, primary prevention focuses on good nutrition, secondary prevention is screening for chronic diseases early and often, and tertiary prevention is akin to chronic disease management.
  2. Empower people to achieve their health goals. The Center will increase patient access to information and tools for disease management and healthy living and align financial incentives with health.
  3. Drive choice with competition. The Center will reduce administrative burden and increase independent provider participation in models, giving patients more options for care at a lower cost.

The Innovation Center will continue to evolve and design new Original Medicare models by leveraging payment and regulatory flexibilities, such as waivers, benefit enhancements and benefit enhancement incentives. Additionally, CMS will expand work to test improvements in Medicare Advantage (MA), drive better spending and outcomes for prescription drugs, and promote efficiency through devices and technology, while continuing to work with states to drive multi-payer approaches to state-level delivery system transformation via existing and new model concepts. 

Also key to this effort under “protecting federal taxpayers” is aligning existing models and initiatives with the strategic objectives will shift financial risk from taxpayers. The work described in the three pillars has potential drive savings based on health promotion and relies less on expensive models of care. CMS  will also ensure protection of the taxpayer through key additional features. Model reviews and new model designs could:

  • Require that all alternative payment models involve downside risk and that a growing proportion of Medicare and Medicaid beneficiaries are in global downside risk arrangements
  • Require that providers bear some of the financial risk and that conveners cannot hold all financial risk
  • Reduce the role of state government in rate setting for health care services
  • Refine and simplify model benchmarking methodology
  • Ensure funds reach those most in need through proper and non-discriminatory provision of funds for health care services
  • Prioritize high-value care and services and incentivize reductions of unnecessary utilization
  • Ensure all model tests are fiscally sound with a pathway to certification

For more information, read CMS’ white paper: CMS Innovation Center’s Strategy to Make America Healthy Again

Additional Information: