Oct 02, 2018

Modernizing Medicare to Take Advantage of the Latest Technologies

Seema Verma
Administrator, Centers for Medicare & Medicaid Services

Modernizing Medicare to Take Advantage of the Latest Technologies

Healthcare is taking up an increasing share of the U.S. economy, and by 2026 the CMS Office of the Actuary projects that one in every five dollars spent in America will be spent on healthcare.  As costs are increasing, we must make the healthcare system more efficient. Significant advancements in biomedicine are changing healthcare delivery for the better, and new technologies can increase efficiency in healthcare by promoting cost-effective care and improving outcomes. Therefore, CMS is focused on encouraging innovation. We must ensure that our beneficiaries have access to the latest medical technologies in order to both improve the quality of care and lower costs.

Today we are announcing a revision of Medicare’s local coverage determination process, which will pave the way to expanded access to new technologies. As part of President Trump’s commitment to strengthening Medicare, we are leaning in to innovation to help drive efficiency and lower costs.

New therapies and technologies are being developed that could not have been imagined in 1965, the year in which the Medicare program was signed into law. However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change. It’s no secret that the government often moves more slowly than private industry — some of our payment policies haven’t been updated in decades. This means that patients may experience unnecessary gaps between FDA approval of a technology and Medicare paying for the technology.

The changes announced today to the local coverage determination process mean that coverage decisions will be more transparent and more responsive to innovators bringing new medical technologies to our Medicare beneficiaries. In this way, the new process will pave the way for expanded access to these technologies. 

As part of our Patients Over Paperwork initiative, we have asked for feedback on which Medicare regulations may be duplicative, outdated or otherwise overly burdensome. Patients Over Paperwork is CMS’s effort under President Trump’s directive to “cut the red tape.”

One area in which we have received extensive feedback concerns Medicare’s coverage and payment policies for innovative therapies and devices. We recognize that confusion exists around some of Medicare’s policies in this area, and that certain products may not have a clear pathway to coverage and payment today. Beyond the changes we’re announcing today, we are considering a series of additional clarifications and improvements to our current policies and processes. The goals are to ensure that there is an efficient, transparent process for covering items and services that have the potential to improve patient care, and that innovators have incentives to invest in developing new technologies that improve the quality of care.

CMS also is working to help beneficiaries experience a healthcare system that leverages the promise of technology we have grown accustomed to in other parts of our lives. We are approaching this from every angle — as one example, earlier this year we released the Blue Button 2.0 application programming interface (API). This digital platform gives Medicare beneficiaries their claims data in a digital format so they can privately and securely use it in electronic applications (“apps”) developed by third parties. These apps can present disparate health information in a consolidated way to help beneficiaries understand their health data and better manage their health right on their smart phones. Hundreds of app developers are currently developing programs that use claims data from Blue Button 2.0.

With the new local coverage determination process, we are taking the first step toward clarifying and modernizing our coverage and payment policies. We look forward to working with stakeholders on this and other initiatives that promote innovation and patient access. Together we can ensure that Medicare beneficiaries see the impact of advances in 21st century biomedicine.

For more information, please refer to the press release: https://www.cms.gov/blog/modernizing-medicare-take-advantage-latest-technologies


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