Analysis: Aspire Health Founder Brad Smith chosen as new CMMI director

• Brad Smith, the founder of Aspire Health, an on-call palliative care provider, was chosen recently as the new director of the Center for Medicare and Medicaid Innovation (CMMI), according to Congressional Quarterly.
• HFMA’s Chad Mulvany says beyond the release of the proposed Part B International Pricing Model, a proposed rule updating the Comprehensive Care for Joint Replacement may be released soon.
• Mulvany also says it will be worth watching how Brad Smith’s experience with palliative care influences new payment models.

Congressional Quarterly is reporting the Trump administration, “tapped Tennessee entrepreneur Brad Smith to lead the office in charge of testing new ways to pay doctors and health plans under Medicare and Medicaid. Smith was chosen as director of the Center for Medicare and Medicaid Innovation over another finalist, Gaurov Dayal, the chief growth officer and president of new markets for ChenMed, a primary care physician group catering to seniors.”

“Smith  is a former political staffer turned health care entrepreneur,” the CQ article continued. “He founded on-call palliative care provider Aspire Health in 2013. He worked for both former Tennessee GOP Gov. Bill Haslam and former Tennessee Republican Sen. Bob Corker, who introduced him to former Senate majority leader and fellow Tennessean Bill Frist — a surgeon, academic and venture capitalist who helped Smith launch Aspire. The company was purchased by health insurance giant Anthem, Inc., in 2018.”  

“The most controversial model under consideration would upend how Medicare pays physicians to administer prescription drugs in part by tying rates to prices paid in other wealthy countries,” according to CQ. “The international pricing index, as it is known, has been parked at the Office of Management and Budget since June. Washington observers have speculated that the administration could be holding the model until the fate of a wide-ranging drug pricing bill (S 2543), led by Senate Finance Chairman Charles E. Grassley, R-Iowa, is resolved. But the chamber’s lack of action on the measure last year effectively punted the debate until at least May, a delay that could affect the administration’s calculus on the model.”

Takeaway

Beyond the release of the proposed Part B International Pricing Model (IPI), which as the CQ article mentions may be held up pending congressional action on drug pricing reform, I would look for the proposed rule updating the Comprehensive Care for Joint Replacement (CJR) to drop soon. We had heard that CMMI staff were hoping to get it out before the holidays, so the lack of a permanent head of CMMI might have caused a delay on it.

This is pure speculation, but I would expect to see technical updates to the target-price methodology that may bring CJR more in line with BPCI-A. I would also, at a minimum, expect to see an extension of the program in the mandatory markets (why else release a proposed rule on the model. Otherwise, you could offer CJR participants a one-time application period into BPCI-A for those that wanted to continue participating on a voluntary basis). Given the findings that LEJR episodes generate savings (even though they’re small) the real question is: Will we see an expansion of the model on a mandatory basis?   

Longer term, given Smith’s expertise, it will be interesting to see if CMMI develops a model focused on palliative care or if existing APMs like the Direct Contract Model or Primary Care First are modified to specifically incorporate or encourage increased utilization of palliative services for seriously ill patients. While the political risk is that it could trigger accusations of rationing or worse, the opportunity to improve outcomes for complex patients is significant and palliative care is underutilized (even among Medicare Shared Savings Program participants). This may even be an area where CMMI finally looks to the Physician-Focused Payment Model Technical Advisory Committee as it has recommended a palliative care model to the innovation center.