CMMI and the Next Generation of Alternative Payment Models
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What is the main topic discussed in this episode?
This episode of AHLA Speaking of Health Law is brought to you by AHLA members and donors like you. For more information, visit American Health Law.org.
Hi everyone. Um, thanks for joining us. My name is Neil Shaw. I am a healthcare shareholder uh in Pulsanelli's Chicago office. I'm also the vice chair of the R HLA's regulation, accreditation, and payment practice group. Um and my guest today is uh Scott Strickland uh in Paul Render's Raleigh office uh and the author of April's HLA Health Blog Connections article, CMMI and the next generation of alternative payment models. Um welcome Scott. Uh maybe you could tell us a little bit about yourself.
Yeah, thanks, Neil. Uh good to be here. Um Let me just shout out uh Raminta Kiziet, my uh colleague here at Hall Render, who co-authored this piece. So um I am in her debt for um much of the content here. So thank you to her. Um, like you said, I'm a shareholder with Hall Render uh in our Raleigh, North Carolina office. Um I won't go into a long drawn-out spiel. About my health law career, but here's the short version. I've been practicing for almost 20 years now, exclusively in the healthcare space. I would describe myself as a healthcare regulatory and transactional attorney. I've been in the value-based care uh end of the pool for quite some time.
What is CMMI and why should health law practitioners care about it?
Uh, really starting with um my tenure um in 2010 in the Office of General Counsel for Health and Human Services, which is um right around the time that the Affordable Care Act was passed, um, they hired a whole bunch of folks, um, program folks and CMS as well as attorneys in the OGC to uh help roll out the Affordable Care Act. And so that's That's how I got started down this road of working with folks at CMS, including yourself, Neil, because that's how we know each other from our days when you were my client. But I worked on a number of initiatives while I was there, including the Medicare Shared Savings Program, a number of fraud and abuse program integrity initiatives, including the Stark Law Self-Disclosure Protocol.
But most notably, and probably the reason that I ended up writing this article and talking to you today is that I helped quite a bit with the alternative payment models that were coming out of the Innovation Center at that time, which was new, the new Center for Medicare and Medicaid Innovation Center, which was part of the Affordable Care Act. And we'll get into more of that later in the podcast. Podcast. But that's how I got started with this. And um almost uh 15 years later, here I am working with a whole bunch of folks around the country on um kind of helping them think through uh strategically and operationally how they're gonna participate in these models and doing so in a compliant fashion.
That's great. Yeah. And we're uh very lucky to uh get the benefit of uh all that experience. Um, you know, being being on the client end with you uh in the so many years ago uh definitely uh have been amazing at uh providing guidance on these complicated programs. So maybe we could start here. Um, you know. The whole focus of this discussion is about CMMI or the Innovation Center, as you referenced. Um, maybe you could provide some background. What is CMMI and why should health lawyers or other help off practitioners um be aware of it and be thinking about it in their practice?
Yeah, um uh great question. So um first of all, like I said, the the Innovation Center Is it's part of CMS. So it is um it's part of that agency. But it was newly created um in 2010 as part of the Affordable Care Act. And so if you go to section, I think 1115A of the Social Security Act, you will see the language establishing the Innovation Center. And it its purpose, um, the reason it was created is to design, implement, and test new or revised healthcare payment and delivery models that are intended to lower healthcare spending for the Medicare program, Medicaid or CHIP, while maintaining or improving hopefully the quality of care provided to those patient populations. So it's essentially like a you know, a a lab, like a testing lab for CMS, um, where it can quickly spin up and roll out these um models or demonstration programs.
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Chapters
7 chapters
1
What is the main topic discussed in this episode?
0:05–1:43
2
What is CMMI and why should health law practitioners care about it?
1:43–8:51
3
Which early CMMI models (e.g., Pioneer, Next‑Gen, REACH) have shaped value‑based care?
8:51–16:26
4
How do CMMI models differ from traditional CMS rule‑makings and regulations?
16:26–24:08
5
What contractual and compliance challenges arise from CMMI’s contract‑based approach?
24:08–31:45
6
How is downside risk being allocated to providers in the new LEAD ACO model?
31:45–40:16
7
What are the key features of the next‑generation CMMI models like LEAD, WISER, and ASM?
40:16–42:14
Speakers
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