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Blum: CMS Committed to Boosting Research on Delivery System Change

By John Reichard, CQ HealthBeat Editor

Interest in testing new ways to pay for and deliver health care is on the rise in health policy circles as the need becomes increasingly urgent for more efficient health care spending. Pending health care overhaul legislation would fund a variety of experimental approaches; noted health policy writer Atul Gawande passionately made the case in a New Yorker article earlier this year for essentially making robust experimentation a permanent feature of the health care system.

Gawande argued that such an approach could benefit health care in the same way that the rural extension service of the Agriculture Department transformed U.S. agriculture in the 20th century.

With health overhaul legislative prospects in doubt, it was perhaps no accident that Jonathan Blum, a top official of the Centers for Medicare and Medicaid Services (CMS), played up the need for a strong research agenda in a speech Monday to the National Rural Health Association. "We are very much committed to returning CMS back into the research world," Blum told rural health care administrators and policy specialists.

Blum is the director of the Center for Medicare Management and the acting director of the Center for Drug and Health Plan Choices at CMS. Essentially, he's in charge of both the traditional Medicare program and the private health plans side of Medicare.

Medically underserved areas would be among the beneficiaries of some of the changes policy makers have in mind. That includes fostering "medical homes" that would improve primary care services to those with chronic illnesses by improving their preventive care and giving them easier access to doctors and nurses to stick with their treatment regimens. But health care generally is seen as benefiting from more research on how to streamline care.

Medicare historically has been a trendsetter for payment changes. Its adoption in the 1980s of prospective payments—a fixed sum of payment for a specific clinical condition—is credited with big savings to the Medicare program without harming quality of care.

"I think it's fair to say that CMS once did very exciting cutting-edge research," Blum noted. "That was a huge priority. That is still a priority today. But I think that the CMS budget has not kept pace with the need for future research and I think sometimes that the CMS research budget gets filled with projects that possibly don't have the most merit."

Blum noted that President Obama proposed in early 2009 "to dramatically increase CMS' research and development budget." He called for a $30 million increase in research on the Medicare and Medicare program; Congress did not fund the request.

But given Blum's remarks, it won't be a surprise if Obama similarly calls for a robust research budget in his upcoming budget proposal. "We think it's important to help Congress lay the foundation for future payment reforms and I expect and the goal really is to make sure that CMS has as strong" an agenda as possible, Blum said.

Blum said that CMS has heard from state officials in Maine and Vermont that the medical home model could best be implemented if all payers—Medicare, Medicaid and private insurers—coordinated in the adoption effort. Blum said that CMS later this year will invite states to apply for a CMS demo to implement an all-payer medical home model. CMS also will solicit proposals later this year for community health centers to serve as medical homes as part of a demonstration project.

CMS also aims to make its huge database of health care claims more readily available to researchers trying to figure out how to improve the efficiency and quality of the current system. "We understand that CMS sits on probably the most valuable health care database in the country," Blum said. "Folks that want to do health policy research do have access to the data, but it's not as transparent and it's not as easy to access as I think some would hope," he observed.

CMS is working with the White House Office of Management and Budget on the issue.

"We are working very closely with our colleagues at OMB to . . . put much more data on line on the cost and the utilization of fee-for-service Medicare services," he said.

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