Charlene Frizzera: Gives Us the Inside Scoop About What’s Going on at CMS

From DOCSF17

Charlene Frizzera, former COO of Medicare with over 30 years in public health, sits with our CEO Breanna Cunningham to expand more on her talk about health policy and what we might see from CMS in the next four years.

A transcription of the entire interview is below:

Breanna Cunningham: Hi there, Bri Cunningham. I’m here with Charlene Frizzera, which we are honored to be able to speak with her. She just gave a fantastic talk about what we can expect in the future regarding the new change in administration and what’s going on in CMS. Charlene has extensive experience with Medicare. Over 30 years?

Charlene Frizzera: Over 30 years, Medicare and Medicaid.

Cunningham: – As the COO in Medicare. One of the things that really resonated, to me, in your presentation was that, often time CMS or the government is viewed as the enemy, and what really came through was that really Medicare has a big heart for its beneficiaries and it’s trying to do innovative things to help make a better product for the end user.

Frizzera: Yep.

Cunningham: Can you speak a little bit to that and how you’ve seen that in your role?

Frizzera: Sure. It sounds a little corny but it is the truth. The people at CMS get up every day trying to design a healthcare delivery system that provides the best healthcare that we can do in this country. The number one goal of CMS is protecting beneficiaries. The best example of that is the lower extremity joint replacement bundle. I mean, it’s a pretty low risk bundle. What they do, they’ll start with something that they feel is low risk to beneficiaries, test that model, see how it works, gather some data, and then think about how they can expand that either to more other joint replacements or expand that in other services. That’s what you’ve seen them do.

They went from lower extremity to all joint replacements. Now there’s a cardiac bundle. They don’t do it irresponsibly, but it does take time. I mean, 100 million people are in the Medicare / Medicaid Program so every decision you make is very important. You can’t make a mistake. If you approve a drug that proves to be harmful to people, that’s horrible. It takes a lot for you to be comfortable that what you’re doing really does positively impact beneficiaries. It’s a tough task.
Cunningham: Sure.

Frizzera: They want the system to work too. Everybody wants the best healthcare system we can possibly have. We’re all on the same side. It’s just a little bit different … The timeline’s a little bit different. People on the outside want things to happen a little quicker.

Cunningham: Tell me, you talked about the total joints, and then expanding from just hips and knees and beyond, and now going into cardiology. Is there any other bundles or verticals within the healthcare space that you see on the horizon that Medicare will be building these bundles with?

Frizzera: Yeah, so I think it’s important, if you take a look at the website, they identified 48 diagnoses that they thought could be bundled. Now, companies voluntarily decided to pick some of those diagnoses to bundle but there’s a list of 48 of them. If you combined that list with where we think the most expensive healthcare is with the least risk to beneficiaries to bundle the payment, that’s where they’re going to go. The cardiac was the next on the list of what they thought worked well. I can’t tell you which ones because I don’t know what the data looks like, but if you’re in the industry and you know those statistics and that information, it’s not hard to figure out where CMS is going to go next.

What’s really important though is, I think again, bundles isn’t the end all and be all. I mean, they’re going to move on from bundles to some other type of payment. There’s a clinical episodic payment demos that they’re designing now where they’re actually going to a clinical episodic payment versus a bundle payment. For example, we are going to pay you X amount of dollars to manage diabetes for these patients. It’s not really bundled in terms of services, it’s [crosstalk 00:03:20]. It’s the entire episode, “Manage that diabetes better and here’s how much we will pay you for that patient in that continuum.” They’re going to continue to just expand the ideas to try to test new models.

I wouldn’t say … I mean, they will continue to bundles. They know how to do them. It’s a pretty good way to reduce costs pretty quickly with the confidence that it’s going to give good quality. They’re going to do other, I mean, not just one of the tests that they’re going to make. They’re going to continue to improve those models. The new administration, I think, will be even more aggressive on innovation and change. I think they’re going to be interested in new and different models than the last administration was.

Cunningham: As Medicare’s designing these alternative payment programs, what is physician’s role? How active were they in the process?

Frizzera: It’s interesting. What CMS will normally, number one, in order to design one of these alternative payment models they need data, which, again, limits what they can do the payment model reform in because they need the data to prove it. They need a certain number of beneficiaries. It can’t be the small, diseased states where there are few beneficiaries. You’re trying to get something that has a bulk of beneficiaries in that space. Then the third is, you hope you find someone who’s going to volunteer to do it. In the end, these bundled payment models, people had to volunteer to do them. It’s important for physicians and providers to support and be a part of those models.

They can’t really happen without them. What we’ve seen is, physicians who are innovative and willing to take a risk are the ones that are the most successful. I’ll give you a very simple example, it’s just in the adoption of IT. When you have a physician who supports that, who’s an IT person, he likes the IT, he supports it, boy, that organization is going to do a great job at really supporting IT. I think it’s important to understand the physician’s perspective on what they think healthcare reform should look like. Those who are sitting in the side and refusing to change, well, we’ll see where they-

Cunningham: They end up.

Frizzera: – they end up in the future.

Cunningham: Sure.

Frizzera: I think a physician buy-in is really important.

Cunningham: Okay.

Frizzera: Yep.

Cunningham:: In your current role, you work with a lot of start-ups and companies that are trying to navigate this very complex web of what is healthcare reform.

Frizzera: Right.

Cunningham: Tell me about some of the challenges or the biggest challenges you’re seeing these companies face, and then what you’re doing to help them solve that.

Frizzera: Sure. One of the things, the very first thing we talk about is, you have to know something about healthcare. You have to be solving a problem. There were a million great ideas out here but if not solving somebody’s problem, it’s going to be pretty hard to convince them to buy it because there are so many problems to be solved. There’s a lot of technology that can solve the problems. We recommend, find a problem and tell people how you can fix it. That’s the number one thing that’s most important. Number two, you need to generally know healthcare. People come in and they know Medicare takes care of people over 65, but they don’t really understand that there’s a ton of regulations, there’s legislation. There’s a lot of regulatory authority over that space.

They need to get educated because it’s very hard to fix a problem when you don’t appreciate some of the regulatory controls that exist for any company, including start-ups. The third I would say is, they need to listen. Most start-ups come to us with a really good idea, and a lot of them are pretty sophisticated ideas, but we find the ones that are the most successful, listen, not just to us. They don’t have to do what we say but they have to at least listen to what we’re saying and not dismiss it. Those who are very defensive about their model, “Well, we’re doing it because … ” “Okay, well you can do whatever you want, it’s not my company, but if you’re not listening to me you’re not listening to anybody. You need to listen because people will have really good ideas for you and really good information that you need to synthesize and figure out how it impacts your model.”

The ones that we work closely with, what we love about them is they’ve listened to people and their models have evolved. Nobody had, the model we have today working with them, is not the model they started with. It’s close, it’s in the same space. They’re smart enough to listen and evolve that-

Cunningham: Be coachable.

Frizzera: – Right, exactly, be coachable. They changed their model into something that will really work.

Cunningham: Mm-hmm (affirmative). Last question I have for you.

Frizzera: Yeah.

Cunningham: As people are trying to keep abreast of what’s going on and stay on top of these changes and the regulations, what is the one go-to source if somebody had ten minutes a day to read, what would you recommend as the one go-to source to keep on top of what’s happening with CMS?

Frizzera: Yeah. I’ll make a couple of recommendations. One, I don’t know that there’s a ten minute place to go, I would say CMS offers a system where you can get automatic alerts when they issue new things. I think that’s really important to sign up for those alerts so you can just get an alert everyday there whenever they’re showing a new demo model or they’re changing some policy, you’ll get an alert that they’ve issued something. I think that’s really, really important. I think the hardest part of keeping abreast is, the industries are still so fragmented. If you just get information about acute care hospital stays, you’re not going to understand that the goal is to put SNIPs and hospitals together for a payment where they’re both at risk for something. I think it’s hard because you can’t really just look at one industry. If you’re not a physician, you should still know what MACRA does.

Cunningham: Sure.

Frizzera: A lot of people, I mean it’s pretty shocking to me, I ask this question all the time. I was talking to a bunch of skilled nursing facilities, I said, “How many of you have ever heard of … What do you know about MACRA?” “Oh, it’s a physician thing.” I’m like, “You guys need to pay attention to MACRA.” I think it’s hard. It is a challenge to stay on top of what’s happening. The other thing I will say that’s really important if you’re trying to figure out change and where change is going, is to monitor the CMMI website.

Cunningham: Okay.

Frizzera: They do a great job of putting on that website all kinds of information about what they’re doing. They put out a lot of very good descriptions about the models they’re trying to test. They put out, what we call, request for information where they ask people, “Please tell us what you think about this idea or this model.”

Cunningham: Wow.

Frizzera: A great example, they just issued one for an accountable care organization for dual eligibles, Medicare / Medicaid beneficiaries. It’s important for people to read that and comment because they’re saying, “We don’t know how to do it. You tell us so that we can help design a good program.” It’s really important to keep an eye on that particular center’s website for CMS. It’s the signal for where they’re moving healthcare delivery in terms of experiments and innovation.

Cunningham: That is so helpful. For all of you listening, keep following that website. Charlene, it was a pleasure.

Frizzera: Good.

Cunningham: Thank you so very much.

Frizzera: Thank you so much. Thanks for asking me.