By Abe Sutton, Director of the Center for Medicare and Medicaid Innovation and Deputy Administrator for the Centers for Medicare & Medicaid Services
Making America Healthy Again: Innovation for Healthier Lives
Transforming our health system for prevention, patient empowerment, and competition
We stand at a defining crossroads in American health care with an unprecedented opportunity to protect taxpayer dollars and fundamentally reshape how we approach health and wellness by embracing preventive care. The CMS Innovation Center — established by Congress to improve the health care system by developing health care payment and service delivery approaches that lower costs and improve quality of care — is uniquely positioned to help steer the course at this crossroads.
Protecting patients and taxpayers from the health care status quo
Our American health care system is hemorrhaging money, chasing disease treatments rather than fixing the underlying health behaviors leading to disease. Doctors, hospitals, and other providers can feel pressured to overschedule patients and deliver unnecessary, duplicative services like repeat testing and other low-value care. Providers often feel limited in their abilities to coordinate care across providers and get to know an individual’s health goals to help reduce disease risk and costly treatments. We’re seeing how these variables show up in real costs to our system, and they’re not trending in the right direction.
- Health care expenditures are growing 2% to 3% faster than our American economy.
- The Medicare trust fund is predicted to be insolvent by 2036.
- Medicaid is the No. 1 expense for most states, crowding out money for essential services like schools and public safety.
- And medical errors are the No. 3 cause of death in America.
It might feel like a lot is stacked against us, but if we work together and let our curiosity lead us in fixing these problems, we have a real opportunity to change our health care system and help people stay healthier longer. We all have a role to play. Real prevention is not simple or easy. Our unhealthiness is deeply embedded in how we live and in our economy. Ultra-processed foods, sugary drinks, and sedentary lifestyles contribute to growing rates of obesity and America’s disease epidemic. Six in 10 Americans battle at least one chronic disease, while 4 in 10 struggles with multiple chronic diseases. Our nation’s life expectancy lags other developed countries, and the cost of maintaining our reactive health care system continues to be far higher than anywhere else in the world.
Helping patients embrace preventive care to Make America Healthy Again
Now is the time to abandon the status quo. The prospects for preventive care have never been stronger. Artificial intelligence is enabling providers to predict and spot health issues before they become symptomatic. Breakthrough cell and gene therapies offer not just management but actual cures for previously untreatable conditions. Digital technologies make health care more accessible and personalized, enabling patients to make informed choices and be active in their health.
The CMS Innovation Center has the tools to break down the barriers and build opportunities to preventive care. Our new, transformative strategy responds enthusiastically to President Trump and Health and Human Services Secretary Kennedy’s call to action to Make America Healthy Again.
With 15 years of experience and lessons learned, Innovation Center pilot programs, called models, have shown promise for supporting preventive care, but most of these models have not met the criteria for nationwide expansion. Focusing on evidence-based prevention will position us for meeting that aim.
For example, our Medicare Diabetes Prevention Program, which features practical training and education, has helped patients meet weight loss goals and lead healthier lives. More than half of the people who took part in the program met and maintained at least 5% weight loss. We heard from one lifestyle interventionist about an elderly client with multiple chronic conditions, including arthritis, who was able to lose 20% of her weight over the course of the program. The woman’s lifestyle changes improved her sleep and ability to exercise and reduced her need for medications. While this intervention has proven results, the Innovation Center has not applied it to other conditions nor built flexibilities to allow patients to do the program asynchronously according to their own schedules.
And, there’s Lamont’s story. After being diagnosed with diabetes, Lamont’s doctor, who is part of our ACO REACH program, took time to understand his health goals and supported lifestyle changes so that he could avoid taking medication. But Lamont’s story is still an outlier in how our providers approach patient care — it needs to be a norm in order to get the quality and financial results necessary to expand a model nationally.
Success stories like these prove that health care transformation through the Innovation Center is possible but we must be more strategic to have a larger impact. We have blueprints for systemic change. And there’s so much more promise in our Innovation Center’s future to build healthier lives.
Innovation Center strategy to build healthier lives
Our health system is at a pivotal moment to Make America Healthy Again. The Innovation Center will seize this moment by establishing logical payment systems that incentivize healthier lives. We will focus on a three-pronged strategy:
- Promote evidence-based prevention: Prevention will be part of every model we test. We will utilize the most effective ways for providers to offer patients services — such as exercise and nutritional support — that promote healthier lifestyles and slow disease progression, as well as provide easier access to evidence-based, complementary and alternative medicine. We will also focus on accurately measuring the outcomes of these interventions to ensure they effectively meet our disease prevention and health promotion goals while saving tax dollars.
- Empower people to achieve their health goals: We will increase beneficiary access to information and tools, including mobile-device applications, for disease management and healthy living. We will also publish data about providers and services, including cost and quality performance, to support beneficiary decision-making and issue waivers to support predictable cost-sharing for certain services, drugs, or devices.
- Drive choice and competition: Building on the progress made by the first Trump administration, we will introduce new programs into Medicare and Medicaid to foster even playing fields and fair competition whenever possible. We will help more providers be part of Innovation Center models, giving patients more options for care and opportunities to benefit from our services. We will make it easier for independent providers to work with us, connect with community-based care, and reduce the administrative burden for those who want to participate in our models.
Now is more than a moment of change. It’s our opportunity to Make America Healthy Again by promoting well-being and protecting our taxpayers’ resources. The Innovation Center is here to lead the way.