Tuesday, January 27, 2009

CMS Administrator: The Pick Is Made, But Who Is It?

We've heard from a few people that the next CMS Administrator has been chosen by the Obama transition team. We're sure the one name we left off the list will get the job, but here are a few names to consider anyway:

Mayo Clinic CEO Denis Cortese: Cortese would be an intriguing pick to lead the agency and seemingly has every qualification to lead the growing Medicare programs: He's an outsider, he holds a medical degree, he manages a large health institution and he's helped to implement a number of the most talked about health reforms at Mayo and made them work. Cortese also chairs the Institute of Medicine Roundtable on Evidence-based Medicine.

The Mayo Clinic Health Policy Center for the last two and a half years, according to Cortese, has developed four principles for reform: 1) getting value out of the provider network, 2) getting integrated and coordinated care, 3) payment reform to pay for value, and 4) insurance for all.

At a November 17 event on health care put together by the Engelberg Center for Health Care Reform, Cortese discussed his views on how to pay for high-value medicine. Here's a window into how Cortese thinks about health reform from comments at the Engelberg event:

"Medicare will have to change the way it does business….One, they need to pay for value. Of all the organizations that can identify where value is, they know where it is. They just need to begin to find—maybe with pilots—some ways to do it."

"They have to get rid of price controls and reduce price controls. Price controls have done nothing to control the rate of spending—absolutely nothing to control the rate of spending throughout the last 30 years or so. And in place of that, put transparency of pricing and value, and the transparency that reports where everybody’s performing."

"There ought to be a mechanism to let people pay more if they choose to do so. Maybe that’s the only way you will get pay for value. Let individuals decide what is of value to them, and let them choose some."

"Allow comparative effectiveness studies to be done. Comparative effectiveness studies are absolutely crucial in helping to decide what to design for coverage and what to actually cover. That currently today is explicitly not allowed for reasons that are vague to me. It’s totally…mindless. It’s another example of a mindless attempt to try to regulate something through Congress, and the unintended consequences are we don’t use evidence to decide anything basically. So you get what you pay for."

Cortese is also on the Mayo Board of Directors along with Tom Daschle.

Institute for Health Care Improvement CEO Donald Berwick:

Berwick is considered a leading authority on health quality and improvement and co-chaired the National Priorities Partnership which put together a report focused on core principles aimed at transforming the health care system.

Berwick has served as vice chair of the U.S. Preventive Services Task Force, the first "Independent Member" of the Board of Trustees of the American Hospital Association, and as chair on the National Advisory Council of the Agency for Healthcare Research and Quality.

He’s also on IoM’s governing council and previously served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Co-chaired by the secretaries of health and human services and labor, the Commission was charged with developing a broader understanding of issues facing the rapidly evolving health care delivery system and building consensus on ways to assure and improve the quality of health care.

He is also clinical professor of pediatrics and health care policy at the Harvard Medical School. Berwick was also at the Engelberg briefing and here's what he had to say about reforming the system and his view of the three major issues standing in the way:

"I think the problem is cost: it's total cost. It is manifestly possible for a Western democracy to give all the care its population needs for about 10 percent of GDP. It is possible. You can't say it's not possible because it's being done. We're at 16 percent or 17 percent. We're wasting probably 40 percent or 30 percent of the dollars we're putting into health care."

"We simply have a toxic dynamic in health care, that if you make something it will be used. No other market works that way. We have to target supply driven care as a matter of public policy. It’s very, very, difficult."

"The second is integrated care for chronic illness and the gaps there in. Seventy percent of costs go into chronic illness care. Probably half of it is pure waste. And a lot of it happens because we don’t have the integrated flows that we need for a restructured care system."

"The third really might be American exceptionalism. It’s our inability to learn from successful models outside of this country. Countries that function with better care than we have; we are 19th out of 19. We’ve got to learn from these other models and not throw them away because we assume that stuff like that doesn’t work here. It will."

The Urban Institute's Robert Berenson: Berenson is a Medicare veteran and is considered a favorite to end up running the agency; he served on the Obama Transition’s agency review group. From 1998-2000, he oversaw payment policy and managed care contracting at the agency. His current research focuses on modernization of the Medicare program to improve efficiency and the quality of care provided to beneficiaries. We think his medical degree is a plus in the coming era of comparative effectiveness research.

Former Avalere exec Jon Blum: The former VP at the health care consultancy Avalere Health where he directed its Medicaid & Long-Term Care practice, Blum is understood to have already left Avalere and is already working at CMS. We’re just not sure in what capacity.

Blum was on the Obama health policy working group working on the transition. Prior to joining Avalere, Blum served on the professional staff of the Senate Finance

Committee and was a lead advisor on the Medicare prescription drug program and played a key role in drafting the Medicare Modernization Act of 2003. He also was an analyst at the Office of Management & Budget.

Harvard's Jeffrey Liebman: We think Liebman is a dark horse candidate to run CMS. He has two key characteristics one would look for in a Medicare Administrator: he was one of three key health advisors to Obama during the campaign and he's an economist.

Along with Harvard's David Cutler and David Blumenthal, Liebman is credited with developing Obama’s health care strategy and projecting cost savings associated with the overall proposal.

His areas of expertise include social insurance, tax and budget policy, poverty, and income inequality. Liebman coordinated the Social Security reform working group and was special assistant to the President under the Clinton Administration.

Harvard's David Cutler: We assumed Cutler would get a top job right out of the gate. After all, Cutler was considered the top health advisor to Obama and serves/ed on the transition's health policy working group. But we heard Cutler was going to coordinate the outside advisors to the campaign as part of the transition and may serve the campaign from his office at Harvard.

If Cutler joins the administration, a spot in the White House is most likely. Still, we don't want to remove someone who is so obviously qualified for the job at CMS from consideration, even if Medicare isn't especially the most attractive job in the administration. It still has a huge impact on the overall health system. Cutler has co-authored health economics papers with Mark McClellan and shares some of McClellan’s views on finding significant cost savings by correcting and reforming the inefficiencies in the system.

Harvard's David Blumenthal: Another David. Another Harvard professor. Another top Obama advisor. Blumenthal is director of Massachusetts General Hospital’s Institute for Health Policy and was a major contributor to the Obama health plan during the campaign. Blumenthal got his start in politics as a professional staff member on Senator Ted Kennedy’s Subcommittee on Health and Scientific Research during the 1970s, which is always a good thing if you're a Democrat. Like Cutler, we expected Blumenthal to be given a post almost immediately after Nov. 5. So far, no word. We've heard that Blumenthal may also serve the administration in a consulting capacity from the outside but until we hear that for sure from a primary source, we're keeping Blumenthal on the list.

Margaret Hamburg: This is a name you may not have heard of until now, but she's an intriguing choice. Hamburg is on the HHS agency review team as part of the Obama transition. She could end up at any number of agencies or remain outside the administration altogether. But here are the three things we think make her an interesting candidate for CMS: she's an MD, she ran a large health care system and she has served in a past administration.

Hamburg was named assistant secretary for policy and evaluation at HHS in 1997 under President Clinton. She was health commissioner from 1991-1997 for New York City...not a small town.

Former Clinton health advisor Judy Feder: The Virginia 10th District Democratic Candidate in 2008 is likely to land somewhere in the administration given her background. The question is, where? The answer may be CMS.

Feder previously served as HHS chief health policy adviser in the role of HHS principal assistant secretary for planning and evaluation under the Clinton Administration. She was the point person with Ira Magaziner during the administration's attempt at universal coverage.

Feder was also staff director on the bipartisan Congressional Pepper Commission on comprehensive coverage. She served as Dean of Georgetown University’s Public Policy Institute between 1999-2007.

1 comment:

Aaron Roland, M.D. said...

Berwick is a trenchant thinker on healthcare who can lead us in the right direction. Obama is right on to have chosen him.