Before he became director of the Center for Medicare and Medicaid Innovation (CMMI), Adam Boehler founded Landmark Health, a provider group that gives chronically ill patients medical care in their homes—and foregoes the fee-for-service model, taking full financial risk. “We never did what we did because somebody paid us per visit. We did whatever it made sense to do to take care of the patient,” Boehler told reporters at an event sponsored by the Alliance for Health Policy on Thursday. Landmark reduced hospital admissions among its patients by 40% and even decreased mortality, he said. Now, Boehler may implement this work on another level. He said it’s “a possibility” that CMMI will create a home health bundled payment model, adding that the agency “will look at everything." Getting Ahead of the Curve: Insights from COVID-19’s Frontlines How is COVID-19 impacting HCPs and patients? Join Daniel S. Fitzgerald, InCrowd CEO & President and Philip Moyer, InCrowd VP of Crowd Operations, to review the key findings. "If I can empower and give accountability to local participants, then they’re going to use what supports they have to derive the best outcomes for patients,” he said. Boehler, who “would like to banish fee-for-service,” suggested a nontraditional payment model would be necessary to do work like Landmark’s through Medicare nationwide. He advocated for an approach that emphasizes accountability so Medicare is paying for the right care, and hinted that CMMI will "get into a rhythm of announcements" over the next several months. RELATED: Future CMS innovation center initiatives could include outcomes-based drug pricing, telehealth It can be difficult and costly for physicians to visit patients in their homes; Landmark paid its physicians nearly 50% above market, he explained. And many physicians prefer to make home visits. “There are plenty of doctors that say, ‘I don’t want to be in an office … and I’d like to see really sick patients because I want to make a difference,’” he added. However, the U.S. faces a growing shortage of both primary and specialty care physicians, including geriatricians. Boehler believes the non-physician healthcare workforce may be able to help fill this gap. RELATED: Healthcare organizations pull out all the stops to attract and retain experienced RNs While state licensing regulations may be a hurdle, nurse practitioners and physician assistants can help with the doctor shortage. Paramedics and social workers as professionals who could possibly step in as well. “I think we have to recognize what we have,” he said. It’s a unique idea for now, though perhaps not implausible. In Boehler’s words, this administration “is not overly sensitive to the status quo.”
The Center for Medicare and Medicaid Innovation (CMMI) may consider creating a home health bundled payment model, according to the organization’s director Adam Boehler. Prior to heading up the CMMI, Boehler founded Landmark Health, which provides home-based medical care to chronically-ill patients and eschews the fee-for-service model, taking full financial risk. By doing so, Landmark cut hospital admissions among its patients by 40 percent and decreased mortality rates, he told an Alliance for Health Policy-sponsored event. “We did whatever it made sense to do to take care of the patient,” he added. Now, it is a “possibility” that the CMMI could create a home health-bundled payment, according to Boehler. He has suggested a non-traditional payment model would be vital to do work similar to Landmark’s through Medicare US-wide. Boehler, who would be keen to end “fee-for-service,” backs an approach based on accountability so Medicare pays for the right care. He indicated that CMMI will make a series of announcements over the next few months. It can be costly for doctors to visit patients at home, and Landmark paid its physicians nearly 50 percent above market price. Many physicians prefer making home visits, but the US faces an increasing shortage of both primary and specialty care staff, including geriatricians. Boehler believes that non-physician healthcare employees – such as nurse practitioners and physician professionals, as well as social workers and paramedics – could fill this gap. While it may be an idea for now, Boehler stressed the administration is not “overly sensitive to the status quo.”