Pulling threads together: GAO Report on Medicaid Demos Triggers Thoughts about CMMI and CMS CED

CMMI is allowed and required to do demos that aim to reduce cost and improve quality.  However, of numerous demos conducted, very few have been able to meet this dual metric.  In part, it's hard to have the data, outcomes, comparisons, and statistics.  Comparisons to historical control groups based on administrative records can be dicey for obvious reasons.  (For disease management, see Al Lewis's book (and blogs) "Why Nobody Believes the Numbers.")   CMMI has published huge collections of project summaries without having much hard data on results.   In a video interview, I once heard former CMMI director Patrick Conway say that CMMI staff were stumped by the hurdles of designing and reporting that would meet the CMS Actuary's accounting standards for cost estimates.  My point.  Maybe a missing link was enough in-service learning sessions between CMMI design staff and CMS Actuary staff to write the rulebook for outcomes and evaluations before starting the $1B a year investments.

A Health Affairs article on innovation acceleration focused on CMMI largely sidestepped the problems in February 2018.  See Perla et al., but wear your happy-hat.  Here.

Similarly, many of the evidence demo projects by the CMS coverage group under "Coverage with Evidence Development" have a mixed history at best.  Here.  And there is NO comprehensive evaluation and lessons learned written about all of them together.

The New GAO Report on Medicaid Demos

In February 2018 GAO released a report that demo follow up was also badly done in Medicaid.  Report here, Dive Healthcare here, MedCityNews here.

• Author Phil Galewitz at MedCity noted that even a big Indiana Medicaid demo's reports were tardy - and the demo was designed by Seema Verma who now heads CMS.

It seems like whether CMS does innovation demos via CMMI, or Coverage "CED" or Medicaid, it's really really hard to pull off the follow-through and execution, probably in some cases, because the up front planning didn't at CMMI or Medicaid have the potential for a successful story arc.  Designing good trials is hard, whether you're a senior expert at NIH or a senior expert at Harvard, and whether you're on staff at CMMI or a Medicaid plan.