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Obamacare Architect Is Top Pick to Lead Value-Based Care Office

Feb. 10, 2021, 8:01 PM

Elizabeth Fowler, who led the drafting of the Affordable Care Act and then implemented the major health law, has emerged as the leading contender to run the Center for Medicare and Medicaid Innovation, according to people familiar with the matter.

Fowler is likely to head the Department of Health and Human Services’ health innovation center and would be charged with carrying out multi-year efforts to send taxpayer dollars toward paying for patient outcomes rather than individual procedures.

The CMMI has expansive authority to create and test health-care payment systems without congressional approval. As costs continue to rise, industry participants and regulators acknowledge they need to find ways to provide quality care while staying financially viable. New payment models are designed to pay doctors more for taking better care of patients and managing the cost.

The HHS and the White House didn’t immediately respond to requests for comment. Fowler declined to comment.

Fowler served in the Obama administration as a special assistant on health care and economic policy at the National Economic Council, as deputy director for policy at the Centers for Medicare & Medicaid Services’ Consumer Information and Insurance Oversight office, and was chief health counsel to former Senate Finance Committee Chairman Max Baucus. She led the drafting of Obamacare in her time working for Baucus.

Since leaving the Obama administration, she has worked at the Commonwealth Fund as executive vice president for programs and at Johnson & Johnson as its vice president for global health policy.

The CMMI has run 54 payment models over the 10 years since its inception. Former Director Brad Smith had begun evaluating which models saved taxpayers money, which models could be expanded, and other long-term retrospective information about the office’s work in the last year of the Trump administration.

Health consultants expect the center will focus its work on further moving to value-based care, including by expanding existing models to more providers, having hospitals and doctors take on more financial risk for their patients, and having them be responsible for the cost of patients’ care if they use more than the payments made under the model.

Taking on financial risk means that if patients use less care than the payments Medicare and Medicaid make to doctors and hospitals, the health-care providers will get to keep some of the savings. But if the patients use more, then the providers may be responsible for the cost, depending on the model.

—With assistance from John Tozzi

To contact the reporter on this story: Shira Stein in Washington at sstein@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Alexis Kramer at akramer@bloomberglaw.com

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