The central role that Medicare, and CMS, play in our healthcare system can not be overstated. There are approximately 64 million Americans in the Medicare program, with annual payments of $1 Trillion, comprising over 20% of the healthcare spend in our country. In addition to its size and scope, CMS, through the Medicare program, is leading the nation in advancing value-based care, and has been deploying landmark historic initiatives at an accelerated pace. This is a unique interview in that we will be hearing directly from the impressive and highly accomplished leader at CMS who is leading Medicare. And, as I promised during the interview, I’ve attached a few links to cms.gov at the end of these notes.
Our guest this episode is Dr. Meena Seshamani who currently serves as Deputy Administrator and Director of the Center for Medicare, at the Centers for Medicare & Medicaid Services. Since joining CMS, Dr. Seshamani has led her team of nearly 1,000 through a critical agenda of initiatives to advance health equity; expand access to coverage and care; drive innovation for high-quality, whole-person care; and promote affordability and sustainability of the Medicare program for generations to come. She is the senior official responsible for CMS’s implementation activities under the Inflation Reduction Act, which is the largest change to the Medicare program since the enactment of Part D in 2003. Dr. Seshamani is a Hopkins trained surgeon and an economist, having obtained a doctorate in economics at Oxford. Prior to joining CMS, she served as Vice President of Clinical Care Transformation at MedStar Health – a multi-hospital system – where she developed & implemented population health and value-based care initiatives. She also cared for patients as a head & neck surgeon at MedStar Georgetown University Hospital and at Kaiser Permanente in San Francisco. Dr. Seshamani served on the leadership of the Biden-Harris Transition HHS Agency Review Team. Prior to MedStar Health, she was Director of the Office of Health Reform at the US Department of Health and Human Services, where she drove strategy and led implementation of the Affordable Care Act across the Department, including coverage policy, delivery system reform, and public health policy.
In this interview, we’ll discover:
- How providers can be aware of the activities at CMS, and how to engage more with CMS.
- Some of the most significant recent changes in Medicare that are coming out of the Inflation Reduction Act, as well as other landmark programs.
- How CMS is encouraging and supporting providers in joining and advancing their participation in alternative payment models like the Medicare Shared Savings Program – the largest accountable care organization in the country.
- How CMS is directly supporting providers in rural America – providers who are caring for tens of millions of Americans.
One of the most landmark initiatives we discussed in this interview was the historic ‘Medicare Drug Price Negotiation Program’. This is the first time ever that Medicare will be negotiating directly with pharmaceutical manufacturers for the prices of some of the highest cost drugs in the Medicare program. It’s fascinating to hear Dr. Seshamani describe the thoughtful and thorough preparation, as well as the ongoing research and assessment that is going into architecting the negotiation process. It’s also compelling to hear that CMS is focused not only on optimizing costs but also on evaluating the real-world effectiveness of these medications. In its first year, the program will focus on ten of the highest cost medications, but those numbers will increase rapidly to cover many more high-cost medications. The law will also cap medication costs for any individual Medicare beneficiary to no more than $2,000 per year.
Another landmark initiative we discussed is the ‘intensive outpatient program’. As Meena eloquently puts it, “We have made some of the most significant changes in behavioral health in the history of the Medicare program – creating entirely new benefits…” For example, these new benefits allow licensed marriage & family therapists, mental health counselors, addiction counselors, and care navigators to become billable Medicare providers – so that beneficiaries receive more whole-person, team-based care, radically improving the way that mental healthcare can be delivered.
I came away from this interview awed by the sheer number of historic, value-based initiatives that CMS is launching – enhancing affordability and equity of care and advancing care in critical areas such as behavioral health. I was also impressed by the transparency and level of engagement that CMS is enabling with providers and the public at large. Another facet that I have to call out is the focus CMS is placing on studying the effectiveness of their efforts, with an emphasis on actual health outcomes in the real-world setting.
There is so much more happening at CMS that we did not have the time to cover. What CMS is doing, and importantly, how they’re doing it, is a manifestation of their courageous, humanistic, conscious leadership. It’s also a reflection of the capability, commitment and integrity of their teams, and their overall palpable dedication to public service.
I came away from this interview hugely inspired and hopeful about the future of American healthcare. We have extraordinary leaders and sophisticated, dedicated teams at CMS – public servants who are advancing and transforming healthcare delivery in unprecedented ways. Their pace, productivity, and impact is remarkable. Their purpose is exemplary. I hope you come away from this interview as catalyzed to engage with CMS as I am. To that end, please take a moment to click on the cms.gov links below – and join in enhancing CMS’s mission.
Until Next Time,
Zeev Neuwirth, MD
- Proposed CY 2024 Physician Fee Schedule Rule:
- Press Release: https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-advances-health-equity
- Behavioral Health Blog: https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare
- General Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
- Medicare Shared Savings Program Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
- Quality Payment Program Fact Sheet (PDF): https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fqpp-cm-prod-content.s3.amazonaws.com%2Fuploads%2F2483%2F2024%2520QPP%2520Proposed%2520Rule%2520Fact%2520Sheet%2520and%2520Policy%2520Comparison%2520Table.pdf&data=05%7C01%7CDiana.Perez-Rivera%40cms.hhs.gov%7Cc22ffc1b576744bc8a6808db83ec982d%7Cfbdcedc170a9414bbfa5c3063fc3395e%7C0%7C0%7C638248824408723905%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=XIEAjHwFCgW8KZskBift7lQrbZ7HUTJdlvQNKztH7Sw%3D&reserved=0
- Proposed Rule: https://www.federalregister.gov/documents/2023/08/07/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other
- Comments due by September 11, 2023
- Proposed CY 2024 Outpatient Prospective Payment System Rule:
- Press Release: https://www.cms.gov/newsroom/press-releases/cms-proposes-policies-expand-behavioral-health-access-and-further-efforts-increase-hospital-price
- General Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center
- Hospital Price Transparency Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-hospital-outpatient-prospective-payment-system-opps-policy-changes-hospital-price
- Proposed Rule: https://www.federalregister.gov/documents/2023/07/31/2023-14768/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment
- Comments due by September 11, 2023
- Proposed CY 2024 Home Health Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-proposed-rule-cms-1780-p
- Rule: https://www.federalregister.gov/documents/2023/07/10/2023-14044/medicare-program-calendar-year-cy-2024-home-health-hh-prospective-payment-system-rate-update-hh
- Comments due by August 29, 2023
- Proposed CY 2024 End Stage Renal Disease (ESRD) Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-2024-end-stage-renal-disease-esrd-prospective-payment-system-pps-proposed-rule-cms
- Rule: https://www.federalregister.gov/documents/2023/06/30/2023-13748/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis
- Comments due by August 25, 2023
- Final FY 2024 Inpatient Prospective Payment System Rule:
- Press Release: https://www.cms.gov/newsroom/press-releases/new-cms-rule-promotes-high-quality-care-and-rewards-hospitals-deliver-high-quality-care-underserved
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
- Rule: https://www.federalregister.gov/public-inspection/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the
- Final FY 2024 Inpatient Psychiatric Facility Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-medicare-inpatient-psychiatric-facility-prospective-payment-system-and-quality
- Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16083/medicare-program-fy-2024-inpatient-psychiatric-facilities-prospective-payment-system-rate-update
- Final FY 2024 Inpatient Rehabilitation Facility Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-inpatient-rehabilitation-facility-prospective-payment-system-final-rule-cms-1781-f
- Rule: https://www.federalregister.gov/documents/2023/08/02/2023-16050/medicare-program-inpatient-rehabilitation-facility-prospective-payment-system-for-federal-fiscal
- Final FY 2024 Skilled Nursing Facility Prospective Payment System Rule:
- Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2024-skilled-nursing-facility-perspective-payment-system-final-rule-cms-1779-f
- Rule: https://www.federalregister.gov/documents/2023/08/07/2023-16249/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities
- Final FY 2024 Hospice Payment Rate Update Rule: