14-05-2025
Medicare innovation lab plays up patient choice, preventive care
Medicare's innovation center plans to put more emphasis on empowering consumers to make personal choices in health care, and on promoting healthier lifestyles to prevent diseases, officials wrote in a strategy memo released Tuesday.
Why it matters: The low-profile office created as part of the Affordable Care Act has wide latitude to try out different health policy experiments and could be a useful lever to implementing Health and Human Services Secretary Robert F. Kennedy Jr.'s agenda.
What they're saying:"The Innovation Center's next phase will focus on testing models that transform the U.S. health system into one that builds healthier lives — through prevention, individual empowerment, and choice and competition," director Abe Sutton wrote in the strategy document.
State of play: The Center for Medicare and Medicaid Innovation has a budget of $10 billion over a decade to run time-limited programs that experiment with alternative ways of paying health care providers in Medicare and Medicaid, with the aim of saving taxpayer dollars and improving care quality.
Going forward, the center will tailor payment models to promote evidence-based preventive care, focusing on health and nutrition counseling, cancer screenings and blood pressure control, Sutton wrote.
Quality evaluations will focus on preventive health outcomes and disease prevention.
Value-based payment models have already allowed some providers to offer services like medically tailored meals and nonemergency medical transportation.
Future models may also offer access to evidence-based alternative medicine, per the memo.
The office said it's aiming to increase Medicare beneficiaries' access to tools like mobile apps for disease management and healthy living. It also will publish data about providers and services, including cost and quality performance, to support beneficiary decision-making.
Reality check: It's hard to generate immediate cost savings with preventive care efforts, and successful center models are supposed to drive down federal spending, said Brian Fuller, a managing director focused on value-based care at ATI Advisory.
"It's definitely the direction the system needs to go. [But] I think, like any strategy refresh, the proof is in the details," he told Axios.
Between the lines: Sutton wants to require all of the center's experiments to involve downside financial risk, where health care providers could lose money if they don't meet certain quality or cost standards.
At the same time, the center will focus on making it easier for providers to participate in payment experiments by cutting down on administrative burdens.
The center also plans to implement new payment experiments within Medicare Advantage, according to the strategy. Historically, its models have focused primarily on driving change in traditional Medicare.
Overall, value-based care providers and experts are optimistic about the Trump administration's plan for realigning incentives in health care and moving away from payments pegged on the volume of services delivered.
"We're excited encouraged by the new supervised strategy built on a lot of the themes that we've been working on a bipartisan thesis for 15 years," said Mara McDermott, CEO of advocacy group Accountable for Health.
