Original Webinar hosted May 19, 2025, 11:00 am ET, link to full recording   

 

Overview

Duke-Margolis, in partnership with West Health, hosted a webinar focused on head and tail winds of accountable care and health system transformation that the Centers for Medicare and Medicaid Innovation (CMMI) are tasked with reshaping.

 

The webinar brought together experts from academia, health policy, and private sectors to discuss CMMI’s plans to innovate, transform, and accelerate value-based care delivery and outcomes across: promoting evidence-based prevention, empowering people to achieve their health goals, driving choice and competition, and protecting federal taxpayers.

 

Speakers highlighted the urgency of innovation in healthcare and the importance of expanding accountability, particularly through standardized model designs and leveraging technology to enhance care delivery.

Fireside Chat with Abe Sutton, CMMI Director and CMS Deputy Administrator

Speakers

• Abe Sutton, Director, CMMI and Deputy Administrator, CMS

• Mark McClellan, MD, PhD, Director, Duke-Margolis Institute for Health Policy

 

Takeaways

• Abe Sutton shared an initial positive reception on the strategy presented earlier this week.

• Noted tertiary prevention as a new priority area for CMMI.

• Downside risk identified as critical for changing provider behavior and driving cost savings.

• Emphasis on making models simpler to administer with standardized design features.

• Technology highlighted for potential to increase healthcare supply and efficiency.

• AI and technology are potential tools for stretching existing healthcare resources.

 

Moderated Panel 1 | Evidence-Based Prevention: From Reducing Risk Factors to Avoiding Unnecessary Complications from Chronic Diseases

Moderator Mark McClellan, MD, PhD, Director, Duke-Margolis Institute for Health Policy

Panelists

• Rushina Cholera, MD, PhD, Executive Director for NC Integrated Care for Kids, Assistant Professor of Pediatrics and Population Health Sciences, Duke University

• Mark Hyman, MD, Co-Founder and Chief Medical Officer, Function Health, Founder and Director, UltraWellness Center

• Will Robinson, Senior Vice President, Accountable Care, HarmonyCares

• Shao-Chee Sim, PhD, MPA, Executive Vice President for Health Policy, Research & Strategic Partnerships, Episcopal Health Foundation

 

Takeaways

• Discussion of prevention across primary, secondary, and tertiary stages.

• Focus on outcome metrics rather than process metrics to track success.

• Early markers like A1C levels highlighted as important intermediary indicators.

• Plan to embed prevention-focused outcome measures broadly across CMMI models.

• Emphasis on identifying high-risk populations earlier (e.g., CKD stage 3 patients), including in pediatrics.

• Dr. Rushina Cholera emphasized family/household approach to prevention and interventions.

• Dr. Mark Hyman discussed 'science of creating health' - changing circumstances to address disease.

• Will Robinson highlighted tertiary prevention for complex patients through home-based care.

• Shao-Chee Sim advocated for policy alignment and building capacity for safety-net providers.

• Panelists discussed non-traditional settings for prevention (churches, community orgs).

• Mark Hyman highlighted AI potential to address physician shortages in rural areas.

• Rushina Cholera emphasized cross-sector data integration to identify rising risk populations.

• Will Robinson stressed the need for technology to support homebound patients.

• Shao-Chee Sim advocated for cross-sectoral collaboration among community resources.

 

Moderated Panel 2 | Empowering Patients and Providers: Understanding the Role of Technology and Data to Drive Engagement

Moderator Namrata Uberoi, PhD, MPH, West Health Policy Center

Panelists

• Omar Manejwala, MD, Chief Medical Officer, DarioHealth

• Andy Slavitt, Founder and General Partner, Town Hall Ventures

• Kevin Volpp, MD, PhD, Director and Professor, University of Pennsylvania Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania School of Medicine and Wharton School; and Scientific Director, American Heart Association’s Health Care by Food Initiative

• Charlotte Yeh, MD, Chief Experience Officer, Cherish Health

 

Takeaways

• Omar Manejwala emphasized engagement focused on what matters to people, not what's the matter with them.

• Need for consumer-focused, intuitive healthcare tools like retail experiences.

• Kevin Volpp highlighted need to make healthier choices easier (e.g., 90-day prescriptions).

• Charlotte Yeh stressed co-design with consumers and understanding their needs.

• Andy Slavitt emphasized trust and solving problems people know they have.

• Charlotte Yeh emphasized Medicare beneficiaries not being a monolith (49% report excellent health).

• Need for different approaches for different segments of senior population.

• Focus on creating 'frictionless workflow of life' and one-stop healthcare shopping.

• Importance of accessibility in technology design for seniors (vision/hearing issues).

• Omar Manejwala discussed technology's role in changing health behaviors. Evidence shows mobile technology can improve blood glucose, blood pressure, mood, and sleep.

• Gap identified: strong evidence for digital health but weak market penetration.

• Technology enables care between visits, influences daily health choices.

• Need for better reimbursement pathways for tech services that cost less than in-person services.

 

Moderated Panel 3 | Increasing Competition Across Markets: Leveraging Accountable Care to Improve Transparency and Improve Affordability

Moderator Rob Saunders, PhD, Senior Research Director of Health Care Transformation, Duke-Margolis Institute for Health Policy

Panelists

• Brian Blase, PhD, President, Paragon Institute

• Martha Wofford, President and CEO, Blue Cross & Blue Shield of Rhode Island

• Tim Gronniger, Chief Executive Officer, Hopscotch

 

Takeaways

• Kevin Volpp stressed the need for predictable patient cost sharing. Example of co-payment only plan making costs transparent ($100 urgent care vs $400 ER).

• Challenge with primary prevention models showing ROI in Medicare's timeframe.

• Andy Slavitt noted AI's potential to expand access and guide decision-making.

• Charlotte Yeh emphasized using AI to provide 'how to' solutions rather than 'should do' advice.

• Omar Manejwala highlighted AI's potential to improve labor force productivity.

• Tim Gronniger welcomed CMMI strategy's focus on promoting independent primary care in underserved areas. Need to solve administrative issues like cash flow challenges for smaller providers.

• Brian Blase emphasized empowering patients and creating more competitive forces in healthcare.

• Martha Wofford highlighted MA plans' flexibility to target benefits for specific populations.

• Need for positive ROI and reduced administrative burden for MA plans to participate.

• Tim Gronniger discussed connecting rural areas to virtual specialty services.

• Need for in-person nexus points (primary care, rural health clinics) for tech-enabled care.

• Brian Blase highlighted importance of appropriateness measures beyond quality measures.

• Discussion of bringing specialty care into value-based payment models.