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OMB's Joseph Grogan acknowledges failure of volume-to-value push

Trump OMB Appointee Blasts Obama-Era Value Programs

By Cheryl Clark
MedPage Today, June 7, 2018

The Obama-era strategy to move the healthcare system from volume to value is too complicated and isn't working well, a Trump administration health official said here Wednesday.

The volume-to-value push has resulted in "a big sprawling complicated series of byzantine programs that few people understand" and it "sucks more value out of the system than it delivers," Joseph Grogan, associate director for health programs for the Office of Management and Budget (OMB), said at the start of a three-day conference on accountable care organizations (ACOs), bundled payments and MACRA.

Grogan took specific aim at the Center for Medicare & Medicaid Innovation (CMMI), a division of the Centers for Medicare & Medicaid Services (CMS) created by the Affordable Care Act. He said his office recently sent a rescission package that includes an $800 million cut from what Congress has appropriated to CMMI, "because so far, CMMI has failed to deliver."

Take, for example, CMMI's experiment with ACOs -- groups of doctors and hospitals working together to deliver high-quality, low-cost care to a defined group of patients. When the Congressional Budget Office scored ACOs in 2011, it estimated that the ACO model called the Medicare Shared Savings Program "would save $4.9 billion over 10 years," Grogan said. But so far, programs using that model have cost over $384 million, according to CMS actuaries.

"There were a lot of broken promises and failed estimates in the ACA. But the hope and promise of these complicated value designs is certainly one of them," he added.

In effect, these designs are trying to get doctors and hospitals to act more like insurance companies, absorbing any losses if their enrollees and beneficiaries end up using too many expensive services, Grogan said. But the complexity of these program designs has become overwhelming.

The Trump administration, he said, is trying to reduce reporting requirements, use broader claims data, begin to move toward passive data collection efforts, "and see if we can get people to spend less time treating codes and entering on an iPad, and concentrate more on the patient."

One problem is the way defenders of these models have tried to justify them, saying the metrics used are unfair, and if different data were used, the picture would be different, Grogan said. "If we're constantly using counterfactuals to evaluate (the programs) and waiting for another study to bear out ... They'll never be termed as failures."

https://www.medpagetoday.com...

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Trump appointee you've never heard of who's reshaping health policy

By Paige Winfield Cunningham
The Washington Post, November 13, 2017

There’s one set of eyes that President Trump’s appointees absolutely cannot ignore as they set about trying to reshape Obamacare and enact sweeping new changes to the government’s health-care programs.

They belong to Joe Grogan, director of health programs at the White House’s Office of Management and Budget.

You’ve probably never heard of Grogan — but you should know who he is. Grogan, perhaps more than any other member of Trump’s administration, holds the power to nix or give the nod to hundreds of regulations shaping how the federal government runs Medicare, Medicaid, the Affordable Care Act marketplaces, the FDA, the CDC and all the other sub-agencies contained within the sprawl of the Department of Health and Human Services.

https://www.washingtonpost.com...

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Comment:

By Don McCanne, M.D.

Finally, a government bureaucrat - Joseph Grogan, associate director for health programs for the Office of Management and Budget (OMB) - acknowledges that the volume-to-value programs such as accountable care organizations (ACOs) are "a big sprawling complicated series of byzantine programs that few people understand." The concept "sucks more value out of the system than it delivers."

Let us hope that he is effective with his intent to "see if we can get people to spend less time treating codes and entering on an iPad, and concentrate more on the patient."

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