The CMS Innovation Center has released a white paper describing the new administration’s strategy to “Make America Healthy Again.” While light on details, the white paper scaffolds the general approach I think we can expect the federal government to take under a second Trump administration when it comes to healthcare. The three pillars of the strategic plan are promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition, but there remains an overwhelming undercurrent of rooting out fraud and abuse in programs – consistent with an overall theme in the current administration’s approach to government. While the Innovation Center paints an optimistic picture, I think there are a few things worth highlighting for leaders to know about the new direction this crucial federal agency. Today I’m discussing the first pillar: promoting evidence-based prevention, and what this looks like under the “new” paradigm.
Functional/Lifestyle Medicine: The Solution for Prevention?
While light on detail, the whitepaper outlines a focus on prevention as a cornerstone for healthy living. There’s explicit reference to functional and lifestyle medicine as distinct from primary care, reflecting a greater perception that these disciplines are somehow separate from the role of the primary care physician.
How did we get here? Historically, these preventative items would have been seen as firmly in primary care’s wheelhouse, but due to poor reimbursement and systemic underinvestment in primary care, reimbursement for prevention has fallen by the wayside, and functional/lifestyle medicine has arisen as an alternative, largely outside the traditional insurance system.
While I think it’s certainly important to focus on prevention, I’m not confident reimbursing these services will move the needle meaningfully. As I’ve touched on in my series on trust, much of the value these services provide is enabled by the additional time and effort practitioners in this space have by virtue of not taking insurance or being tied down in federal funds. I’m open to being proven wrong, but I don’t think this is a step in the right direction.
Global Risk
We also have the first mention of the need to take on global risk in this section, specifically in the context of DME, but also with a nod to reducing cost-sharing for other preventative services. This will become a theme later in the document when it comes to driving choice and competition.
Aligning Quality Measures
Finally, there’s acknowledgment that some of the current quality measures we use are not well-aligned with health outcomes. On this point, I wholeheartedly agree. Instead, the document suggests a renewed focus on health outcomes that matter to people, like days at home for frail elderly individuals. There’s also mention of the fact that measuring the impact of preventative interventions is challenging and will require “intermediate markers” to track success. This is, of course, the big bugaboo for anyone in quality, but I’m glad to see someone acknowledging that the process measures we currently use might not be well-aligned with the outcomes we’re looking for. This certainly seems like a step in the right direction.
In all, I think it’s a mixed bag where prevention is concerned – some important insights on the need for better measurement markers aside, it’s largely more of the same in preventative care. Next, I’ll cover my take on the second pillar, empowering people to achieve their health goals – and why global risk might not be the panacea CMS is hoping.