Abe Sutton

CMS is inviting organizations to apply for the MAHA ELEVATE Model! The @CMSinnovates' MAHA ELEVATE model is the first Innovation Center model to focus on holistic, patient-centered functional or lifestyle medicine approaches that include nutritional, physical activity interventions, psychological and/or self-care strategies to address the whole person rather than individual disease. It’s what the MAHA Movement is all about! We’ll award ~$100 million total to fund up to 30 proposals with evidence-based functional and lifestyle medicine interventions so more people with Original Medicare can join these programs. Learn more: cms.gov/priorities/inn…

I had the honor to join Julie Yoo & Rohit Chandra to discuss #ACCESS at this week’s #ViVE health tech conference. ACCESS helps make managing chronic conditions more affordable and within reach using technology supported care. Learn more + apply now: go.cms.gov/ACCESS

At CMS, we’re laser focused on helping Americans be healthy by making it easier to access technology-supported care. So today, we brought together major health plans to sign the ACCESS Payer Pledge – promising greater consistency across Medicare, Medicaid and commercial payers, and making digital health technologies more accessible. Learn more: go.cms.gov/ACCESS

CMS Administrator Dr. Oz commented on the launch of TrumpRX, a direct-to-consumer (DTC) platform selling drugs at discounted prices under the most-favored-nations (MFN) model. According to the CMS administrator, “These are U.S. government-negotiated Most Favored Nation prices. It is an elegant solution to the problem facing so many Americans... with 90% discounts, we have an ability now to completely reset expectations for the American people.” Also commenting on TrumpRX, FDA Commissioner Dr. Makary said, “TrumpRX is the beginning of a new chapter in American health care where—for the first time—you can buy the drug from those who make it… The amount of money games that go on with health care’s middlemen… are unbelievable.” According to HHS General Counsel Mike Stuart, “Based on a review of the applicable facts, earlier today the HHS Office of the General Counsel referred Hims & Hers Health, Inc. (‘Hims’) to the Department of Justice for investigation for potential violations by Hims of the Federal Food, Drug, and Cosmetic Act and applicable Title 18 provisions.” Secretary Kennedy commented on a meeting he held with Tennessee Governor Lee. According to the HHS Secretary, “This week, I met with Governor Bill Lee of Tennessee, a key partner in the MAHA movement. Tennessee is leading the way by banning Red 40 from school meals, strengthening fluoride transparency in public water systems, limiting student cell phone use in schools, and requesting a SNAP waiver that restricts the purchase of sugary drinks and candy. Together, we will Make America Healthy Again.” According to a recent study shared by the NIH, “Researchers found that prescription stimulants for ADHD act on brain networks that control wakefulness and reward, but not attention as previously thought. The study suggests that stimulants and additional sleep affect the brain in similar ways, and that getting enough sleep could help in managing [ADHD symptoms].”

Go to TrumpRX.gov. This is our effort to make all those drug negotiation prices available to you.

LEAD includes flexibilities designed to enable Americans to live healthier lives #MAHA I hope LEAD will appeal to a broad array of providers, and my team and I are excited to work to recruit participants to join LEAD over the years ahead.

LEAD will fix the data access issues prior ACO models have experienced. It also goes further than any CMS Innovation Center Model has ever gone to give physicians serving patients in Original Medicare flexibilities previously only seen in the Medicare Advantage program

Accountable care is a theoretically promising approach to deliver proactive, holistic care to people enrolled in Medicare in way that will help them lead healthier lives, experience higher quality care, and require less medical spend over time

Obamacare proved that one-size-fits-all health insurance is a recipe for skyrocketing costs. Exchange premiums are set to surge by 18% next year due to the unsustainable structure Obamacare imposed. For too many families, health care now exceeds housing as a budget item. While Biden’s answer to this was more taxpayer money shoveled out without strategic planning in an unsustainable manner that is now set to expire, we know the solution is choice and competition to serve people. We are giving Americans new flexibility to choose the plan that is right for them. We trust the American people and are committed to affordable options. @CMSGov

Estimates for the cost of unnecessary or ineffective healthcare interventions range from 10-30% of total spend. Any serious effort to reduce costs and improve care must address this. The WISeR model proposed by CMS will face pushback, but is an important step forward. Many procedures, tests, and drugs have no clinical benefit, but almost all interventions have risks and side effects. A well-run health system protects patients from unnecessary and even harmful services and protects the taxpayer and patient from unnecessary spending. There’s a place for targeted utilization review that occurs before the unnecessary service is delivered and the claim is paid. Some Medicare Advantage plans arguably overuse prior authorization, creating unnecessary friction for patients and providers. Meanwhile traditional Medicare rarely applies it, paying for all care regardless of benefit. The WISeR model is a small pilot by CMS to add prepayment review aided by a mix of technology and clinicians for select low-value services in 6 states. If anything, I think it moves too cautiously, but CMS is right to be careful to ensure the incentives and guardrails are set properly. While prior auth in MA has left many clinicians and patients uneasy, the WISer model is designed to improve health outcomes and reduce costs without imposing needless burdens on providers. It's a smart reform and deserves support.

To learn more: cms.gov/priorities/inn…

WISeR shouldn’t be controversial. It should become the standard for how care should be paid when there is a risk of patient harm.

Prior authorizations spark frustration associated with delays, denials, and administrative burden that gets in the way of providers workflows and patient care. That is why, Secretary Kennedy and Administrator Oz announced a pledge to address the overuse of prior authorization.