NE Washington News

Washington D.C. — House Energy and Commerce Subcommittee on Health Chair Brett Guthrie (R-KY) delivered opening remarks at the subcommittee hearing titled “Checking-In on CMMI: Assessing the Transition to Value-Based Care.”

“Thank you to our witness, Dr. Liz Fowler, for being here with us today as we ‘check-in’ on the Centers for Medicare and Medicaid Innovation’s progress in lowering costs and improving quality of care paid for by Medicare and Medicaid," Guthrie stated.

“Our health care system has undergone significant changes over the last decade, and Americans continue to cite health care costs as a top concern. More Americans are stuck paying more for health care than they ever have in the past.”

Guthrie highlighted that taxpayers are also bearing higher health care expenditures. “In 2022, health care spending grew by 4% year-over-year, reaching $4.5 trillion, nearly 17% of U.S. gross domestic product,” he said. “During this same time, spending on hospital care reached 30% of total health care spending while physician and clinical services reached 20% of all health care spending.”

He noted that physicians are now required to spend more hours on administrative tasks in efforts to keep costs low.

Addressing the role of CMMI, Guthrie remarked, “Policy makers and stakeholders from across the health care system have hoped that by embracing value-based care, high costs and physician burnout would be addressed, and patients would receive a higher quality of care."

“The Centers for Medicare and Medicaid Innovation was supposed to be a key driver of this movement toward value-based care," he continued. "However, Medicare and Medicaid’s transition to value-based care has clearly stagnated."

Guthrie pointed out that CMMI was established under the Affordable Care Act with goals of improving patient outcomes and slowing cost growth in Medicare and Medicaid programs. He referenced a September 2023 Congressional Budget Office report which found that CMMI’s activities increased spending by almost $5.5 billion.

“Under the Biden administration, the Center has undertaken an internal reevaluation,” he said. “While I would hope this strategic refresh would generate a renewed commitment to better fulfilling CMMI’s mission of reducing costs and improving quality in its second decade... I must admit I am concerned the Center has instead further shifted focus from its Congressionally anointed purpose.”

Guthrie expressed concerns about specific actions taken by CMMI that could hinder the transition to value-based care. He criticized the Accelerating Clinical Evidence model which proposes slashing payments to Part B providers prescribing FDA-approved therapies through the Accelerated Approval Pathway.

“This not only undermines the FDA gold standard but penalizes those attempting to drive transformative change for patients that otherwise lack treatment options,” he stated.

He also voiced concerns about CMMI’s Cell and Gene Therapy Access Model which may limit states' ability to use value-based agreements for curative cell-and-gene therapies approved by FDA.

“We have 50 incubators across the country in our state Medicaid programs... By CMS directly negotiating drug rates for these therapies, it weakens states' ability to negotiate directly with manufacturers or form state compacts,” Guthrie explained.

He urged CMMI and CMS to work with Congress on passing his MVP Act with Ranking Member Eshoo which aims to codify CMS’ multiple best price rule allowing states greater flexibility in using value-based agreements.

“In closing, I hope today’s discussion helps us chart a path forward for CMMI that can ensure the center is better delivering on its mission... reenergize the transition to value-based care,” Guthrie concluded.

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