MITRE's Expanding Role in Health Care Policy
Andrew Bremberg
March 2013
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MITRE's Andrew Bremberg assists the Centers for Medicare & Medicaid Services in developing and implementing health care policies. |
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One of the biggest challenges in our nation's near future is improving and reforming our health care system. With the establishment of a new MITRE-operated federally funded research and development center (FFRDC) for the Centers for Medicare & Medicaid Services (CMS)—named the CMS Alliance to Modernize Healthcare—we are committed to helping CMS and its parent organization, the Department of Health and Human Services (HHS), develop the necessary policies to implement these reforms.
Over the past decade, much of MITRE's work in the health arena has focused on improving health care through technology-based transformation. Recently, however, especially as our work has expanded to new tasks in the health care mission area, CMS has explicitly asked us to assist in developing and implementing policies for the future. The CMS Alliance to Modernize Healthcare will assist with managing the agency's complex health benefits programs, including fulfilling critical thinking requirements that encompass the business, policy, technology, and operational interests across CMS and HHS.
The mission is clear. "Our goal is to help our government sponsor develop and implement policies that will result in better quality health care at lower costs," says Andrew Bremberg, a principal health policy analyst and department head in MITRE's Center for Transforming Health (CTH).
He leads a team of eight CTH policy analysts who are working with CMS to develop and implement health care policy in numerous settings. Bremberg is an attorney by training and former HHS official who came to MITRE in 2009.
Better Care, Lower Costs
While several of the specific reforms of the 2010 Affordable Care Act remain contentious, many of the broad goals of health care reform are widely accepted. "Most people agree that the primary goal is to improve the quality of care while also decreasing the costs of providing it," Bremberg says.
Much of his team's work focuses on developing health care policies that shift the financial incentives for providers to encourage higher quality and more cost-effective services. The reform of payment models is a key component to lowering costs.
Traditionally, the main way most health care services have been paid for is the fee-for-service (FFS) payment structure, where providers receive a separate payment for each service. Most potential new payment models fall into one of three general areas: value-based purchasing (VBP), accountable-care organizations (ACO), and bundled payments.
VBP models build upon the existing FFS structure, but adjust provider payment based on their performance on quality measures. In an ACO payment structure, providers receive incentives to take responsibility for individuals' health care services and keep them healthy, regardless of what specific services are necessary. In the bundled payment structure, providers receive a fixed reimbursement amount for a group of services and assume the financial risk if a patient incurs additional costs.
MITRE collaborates closely with CMS's new Center for Medicare & Medicaid Innovation (Innovation Center) to develop and test various new payment models. "The Innovation Center is tasked with testing alternate payment and service delivery models," Bremberg says. "We're working closely with our partners at The Brookings Institution and the RAND Corporation to provide expert assistance to the Innovation Center as they design and evaluate new ideas."
"One of the things we are working on with CMS is developing programs that use different payment models. The goal is to shift the financial incentives for providers so that the objective is to pay for quality—pay more for better care and pay less for worse care."
However, Bremberg is quick to point out that health care policy is much more than establishing and implementing new programs. "To move from an old program to a new one, you have to understand how the existing programs work and the regulatory processes they are subject to. From a policy perspective, you have to know how you're going to get from point A to point B.
"If you want the new program to succeed, you have to identify, articulate, and address all the surrounding issues and build consensus among the participants and other stakeholders."
Diversity of Projects and People
Not all of Bremberg's work involves CMS. Recently, he and his team supported a project for the Department of Veterans Affairs and the Department of Defense.
"The VA has a pharmacy program for veterans, and the DoD has a different pharmacy benefit program for military personnel and their families. It's a classic case of two similar programs run by separate federal agencies struggling to work well together. The government asked MITRE to do an independent assessment and develop ways to better align these programs and reduce costs." MITRE's Center for Veterans Enterprise Transformation (CVET) staff sought out health policy experts to assist with the project, and Bremberg volunteered his department's analysts.
Bremberg acknowledges that he enjoys tackling big issues and working with the multi-disciplinary teams from across the corporation.
"The health care space is an area of massive change. Improving quality, lowering costs, expanding coverage—all of those efforts will be changing fundamentally under the Affordable Care Act. Health care and health care financing remain among the biggest challenges our nation is facing, and we are committed to helping our government sponsors in meeting this challenge."
Now in his fifth year with MITRE, Bremberg appreciates both the collaborative atmosphere and the diversity of knowledge here.
"I value the opportunities I've had to work with people who have very different backgrounds and domain expertise. It's been very fulfilling professionally. Add to that MITRE's commitment to helping employees achieve a healthy work-life balance, and it's been a fantastic place to work."
—by Kay M. Upham
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