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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Page xiii Cite
Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Suggested Citation:"Front Matter." National Research Council. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. Washington, DC: The National Academies Press. doi: 10.17226/26675.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

THE LEARNING HEALTH SYSTEM SERIES Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation National Academy of Medicine NAM Leadership Consortium: Collaboration for a Learning Health System THE NATIONAL ACADEMIES PRESS Washington, DC www.nap.edu PREPUBLICATION COPY - Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention but does not constitute endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine. This initiative was convened with support from The Commonwealth Fund. Any opinions, findings, or conclusions expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for this project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26675 Library of Congress Catalog Number: 2022XXXXXX Copyright 2022 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academy of Medicine. 2022. Catalyzing Innovative Health System Transformation: An Opportunity Agenda for the Center for Medicare & Medicaid Innovation. P. S. Chua, A. Anise, J. Lee, M. Cohen, P. Conway, J. Harris, P. Long, M. B. McClellan, D. Muhlestein, A. S. Navathe, R. Onie, E. Park, and R. Perla, editors. NAM Special Publication. Washington, DC: National Academies Press. https://doi.org/10.17226/26675. PREPUBLICATION COPY - Uncorrected Proofs

“Knowing is not enough; we must apply. Willing is not enough; we must do.” -GOETHE PREPUBLICATION COPY - Uncorrected Proofs

ABOUT THE NATIONAL ACADEMY OF MEDICINE The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. Learn more about the National Academy of Medicine at NAM.edu. PREPUBLICATION COPY - Uncorrected Proofs

CATALYZING INNOVATIVE HEALTH SYSTEM TRANSFORMATION: AN OPPORTUNITY AGENDA FOR THE CENTER FOR MEDICARE & MEDICAID INNOVATION Expert Panel and Steering Committee MANDY COHEN, Aledade Care Solutions PATRICK CONWAY, Care Solutions, Optum JULIAN HARRIS, Healthcare Services, Deerfield DORA HUGHES, The George Washington University (until July 2021) PETER LONG, Blue Shield of California CINDY MANN, Manatt Health (until August 2021) MARK B. MCCLELLAN, Robert J. Margolis Center for Health Policy, Duke University DAVID MUHLESTEIN, Leavitt Partners AMOL S. NAVATHE, Perelman School of Medicine, University of Pennsylvania REBECCA ONIE, The Health Initiative EDWIN PARK, McCourt School of Public Policy, Georgetown University ROCCO PERLA, Co-Founder, The Health Initiative MEENA SESHAMANI, MedStar Health (until July 2021) NAM Staff Development of this publication was facilitated by contributions of the following NAM staff, under the guidance of J. Michael McGin- nis, Leonard D. Schaeffer Executive Officer and Executive Director of the Leadership Consortium for a Value & Science-Driven Health System: PEAK SEN CHUA, Consultant AYODOLA ANISE, Deputy Director, NAM Leadership Consortium JENNIFER LEE, Visiting Scholar (until June 2022) JENNA L. OGILVIE, Deputy Director of Communications ALLISON LESTER, Senior Program Assistant (until March 2022) OLIVIA MATONGO, Program Officer (until November 2021) ARIANA BAILEY, Senior Program Assistant (until August 2021) PREPUBLICATION COPY - Uncorrected Proofs v

NAM LEADERSHIP CONSORTIUM: COLLABORATION FOR A LEARNING HEALTH SYSTEM MARK B. MCCLELLAN (Chair), Duke University AMY ABERNETHY, Verily SHANTANU AGRAWAL, Anthem, Inc. JEFFREY BALSER, Vanderbilt University Medical Center GEORGES BENJAMIN, American Public Health Association RACHELE BERRIA, AstraZeneca DAVID BLUMENTHAL, The Commonwealth Fund NAKELA COOK, Patient-Centered Outcomes Research Institute (PCORI) KAREN DESALVO, Google JUDITH FAULKNER, Epic Systems DAVID FEINBERG, Cerner JULIE L. GERBERDING, Merck & Co., Inc. SANDRA HERNANDEZ, California Health Care Foundation DIANE HOLDER, UPMC Health Plan MICHELE HOOD, American Hospital Association FREDERICK ISASI, Families USA ADAM LENKOWSKY, Bristol Myers Squibb PETER LONG, Blue Shield of California JAMES L. MADARA, American Medical Association LAURA MAURI, Medtronic SUZANNE MIYAMOTO, American Academy of Nursing VALERIE MONTGOMERY RICE, Morehouse School of Medicine MARY D. NAYLOR, University of Pennsylvania HAROLD PAZ, Stony Brook University JONATHAN B. PERLIN, The Joint Commission RICHARD PLATT, Harvard Medical School DWAYNE PROCTOR, Missouri Foundation for Health KYU RHEE, CVS Health, Aetna JOHN W. ROWE, Columbia University LEWIS G. SANDY, UnitedHealth Group LEONARD D. SCHAEFFER, University of Southern California BRUCE SIEGEL, Americaʼs Essential Hospitals DAVID SKORTON, Association of American Medical Colleges JENNIFER TAUBERT, Johnson & Johnson REED V. TUCKSON, Tuckson Health DEBRA B. WHITMAN, AARP PREPUBLICATION COPY - Uncorrected Proofs vii

NAM Leadership Consortium Staff LAURA ADAMS, Senior Counsel AYODOLA ANISE, Deputy Director SARAH GREENE, Senior Counsel AMANDA HUNT, Senior Program Officer J. MICHAEL McGINNIS, Executive Director ANNIE MURFF, Senior Program Assistant ASIA WILLIAMS, Research Associate PREPUBLICATION COPY - Uncorrected Proofs viii

REVIEWERS The products that compose this volume were reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine (NAM). We wish to thank the following individuals for their contributions: IGNATIUS BAU, Independent Consultant CHRIS DEMARS, Oregon Health Authority TRICIA McGINNIS, Center for Health Care Strategies JORGE PETIT, Coordinated Behavioral Care, Inc. The reviewers listed above provided many constructive comments and suggestions, but they were not asked to endorse the content of the publication and did not see the final draft before it was published. Review of this publication was overseen by AYODOLA ANISE, Deputy Director, Leadership Consortium, PEAK SEN CHUA, Consultant, JENNIFER LEE, Visiting Scholar, and J. MICHAEL McGINNIS, Leonard D. Schaeffer Executive Officer. Responsibility for the final content of this publication rests entirely with the editors and the NAM. PREPUBLICATION COPY - Uncorrected Proofs ix

PREFACE Continuous learning aligned with multi-stakeholder engage- ment is critical in driving the nation’s health and health care sys- tem toward improved effectiveness, efficiency, and equity. Since its founding in 2010 as a key provision of the Affordable Care Act, the Center for Medicare & Medicaid Innovation (CMMI) has tested over 50 alternative payment models reaching more than 28 million patients across 528,000 health care providers and plans, yielding invaluable insights on the implementation of models to achieve better care, better health, and lower costs. In the ensuing decade, the field’s understanding of the necessary programs, policies, and efforts to achieve equity, affordability, and value has advanced considerably. On the other hand, many basic lessons learned are lessons unap- plied. The U.S.ʼ population health outcomes lag behind its highly economically developed peers. Our nation’s health system is still firmly entrenched in the fee-for-service payment system that re- wards service volume. This system has delivered lackluster health and health care access, outcomes, efficiency, and affordability. Ad- ditionally, health care expenditures continue to rise despite multi- dimensional disparities in morbidity, mortality, and overall health and well-being. During the COVID-19 pandemic, the health sys- tem’s emphasis on volume instead of value and the society-wide impacts of structural racism were exposed to poor overall outcomes and worsened health outcomes for marginalized populations. The opportunity, indeed the obligation, is clear for CMMI to en- hance its role as a catalyst of the changes needed. Reflecting this urgency, CMMI leadership began consultations and outreach ef- forts in service of its updated strategic plan in early 2021. Antici- pating CMMI’s need for guidance and technical advice, the Nation- al Academy of Medicine (NAM) sought to leverage its strengths in xi

xii | Preface convening field stakeholders and industry leaders to inform this updated strategic plan. With the generous support of the Common- wealth Fund, NAM launched its two-phase Catalyzing Innovative Health Transformation initiative in March 2021. In the project’s first phase, NAM convened an Expert Panel of preeminent and innovative leaders to assess the state of health financing and care delivery. In the culminating Expert Panel Re- view, the panel urged CMMI to focus on targets and measures to enhance beneficiary interests, equity in payment policy, commu- nity and social drivers of health, and multi-payer alignment on value-based care. The Expert Panel was refashioned into a Steering Committee in the second phase. The Steering Committee and NAM convened interactive discussions on Multi-Payer Alignment on Value-Based Care and Collecting Data to Ensure Equity in Payment Policy. Recognizing that these two domains are crucial to reducing fee-for-service dominance, these discussions reviewed landscape of challenges faced and illuminates the strategies CMMI can pur- sue to achieve systems transformation. Ultimately, these efforts informed CMMI’s Strategic Refresh, which was launched in October 2021. CMMI’s updated strategic plan cited NAM’s efforts in refocusing the center’s aim on transi- tioning the health system toward value-based care and achieving equitable outcomes through high quality, affordable person-cen- tered care. The initiative also sought to inform CMMI’s efforts be- yond the Strategic Refresh. Across the initiative, stakeholders and field leaders signaled to CMMI the boundless possibilities from a stakeholder engaged transformation that co-develops approaches, strategies, deliverables, and supports. This Special Publication, the Opportunity Agenda for CMMI, is a product of this effort—a resource for CMMI as it advances its strategic agenda. It outlines the need to center beneficiaries as the north star, assure the primacy of equity as well as linkages with community and personal drivers of health, and align payers to re- ward whole person and population health. Moreover, the conven- ings emphasized the compelling, disruptive opportunities CMMI could harness by refocusing its operative approach. Constructing systems that reward whole person and population health at scale PREPUBLICATION COPY - Uncorrected Proofs

Preface | xiii will require more creative, engaged, and co-developed tactics, strategies, and programs. These efforts include CMMI using its convening power to align various stakeholders within the health ecosystem, assessing the current landscape of efforts, identifying new ways to personal- ize and support external stakeholders, engaging stakeholders in co-developing models and data collection efforts, testing models more rapidly, and aggregating available data to supercharge cur- rent efforts. The National Academy of Medicine and the NAM Leadership Con- sortium for a Learning Health System, look forward to assisting CMMI and its stakeholders throughout the nation—from individu- als, families, and communities to payers, providers, employers, and states—in advancing a health system that reaches its potential for effectiveness, efficiency, equity, and continuous learning. J. Michael McGinnis Leonard D. Schaeffer Executive Officer Executive Director, NAM Leadership Consortium National Academy of Medicine PREPUBLICATION COPY - Uncorrected Proofs

CONTENTS Acronyms and Abbreviations, xxi 1 Introduction and Initiative Background, 1 2 Expert Panel Review Highlights, 5 3 Multi-Payer Alignment on Value-Based Care Discussion Highlights, 9 4 Collecting Data to Ensure Equity in Payment Policy Discussion Highlights, 17 5 CMMI Priority Actions and Implementation Considerations, 25 6 Conclusion, 35 References, 37 APPENDIXES A Expert Panel Review, 39 B Multi-Payer Alignment on Value-Based Care Discussion Proceedings, 53 C Collecting Data to Ensure Equity in Payment Policy Discussion Proceedings, 73 D Case Studies Developed for September 28, 2021, Meeting on Multi-Payer Alignment on Value-Based Care, 93 E Meeting Participants for September 28, 2021, Meeting: Multi- Payer Alignment on Value-Based Care, 107 F Meeting Agenda for September 28, 2021, Meeting: Multi-Payer Alignment on Value-Based Care, 111 G Meeting Participants for November 1, 2021, Meeting: Collecting Data to Ensure Equity in Payment Policy, 115 H Meeting Agenda for November 1, 2021, Meeting: Collecting Data to Ensure Equity in Payment Policy, 121 PREPUBLICATION COPY - Uncorrected Proofs xv

BOXES AND FIGURE Boxes 1 Expert Panel Review Anchor Commitments, 6 2 Center for Medicare & Medicaid Innovation Strategic Objectives, 26 Figure 1 Arkansasʼs CPC+ Track 1 and Track 2 Payment Structure, 97 PREPUBLICATION COPY - Uncorrected Proofs xvii

ACRONYMS AND ABBREVIATIONS ACA Affordable Care Act ACO Accountable Care Organization ACT adult changes in thought AHC Accountable Health Communities model AHCPII Arkansas Health Care Payment Improvement Initiative APM alternative payment model CAHPS Consumer Assessment of Healthcare Providers and Systems CCSQ Center for Clinical Standards and Quality CHIP Childrenʼs Health Insurance Program CMCS Center for Medicaid and CHIP Services CMMI Center for Medicare & Medicaid Innovation CMS Centers for Medicare & Medicaid Services COVID-19 coronavirus disease 2019 CPC Comprehensive Primary Care model CPC+ Coordinated Primary Care Plus CPT Current Procedural Terminology ED emergency department EPHC Enhanced Personal Health Care program ER emergency room FFS fee-for-service HCC Hierarchical Condition Category HCP-LAN Healthcare Payment Learning and Action Network HEDIS Healthcare Effectiveness Data and Information Set HESS Health Equity Summary Score HHS U.S. Department of Health and Human Services HIE health information exchange HITECH Health Information Technology for Economic and Clinical Health Act INCK Integrated Care for Kids Model IT information technology PREPUBLICATION COPY - Uncorrected Proofs xxi

xx | Acronyms and Abbreviations LGBTQ+ lesbian, gay, bisexual, transgender, and queer or questioning NAM National Academy of Medicine NASHP National Academy for State Health Policy NCQA National Committee for Quality Assurance NQF National Quality Forum NQIIC National Quality Improvement and Innovation Contractors ONC Office of the National Coordinator for Health Information Technology PBGH Purchaser Business Group on Health PBPM per-beneficiary per-month PCF Primary Care First model PCP primary care provider PCMH Patient-Centered Medical Home PCP Primary Care Practices PFAC Patient and Family Advisory Council PMPQ per-member per-quarter QIN-QIO Quality Innovation Network Quality Improvement Organizations SHARE Arkansas State Health Alliance for Records Exchange SOGI sexual orientation and gender identity VBC value-based care VBP value-based payment PREPUBLICATION COPY - Uncorrected Proofs

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