Listening Session Brad Smith, Deputy Administrator and Director of CMS

Last week the Nashville Health Care Council hosted a virtual listening session with Brad Smith, deputy administrator of the Centers for Medicare and Medicaid Services (CMS) and director of the Center for Medicare and Medicaid Innovation (CMMI), for more than 263 Council members. Smith — formerly the chief operating officer of Anthem’s diversified business group; co-founder and CEO of Aspire Health; chief of staff at the Tennessee Department of Economic Development; and the founding executive director of the Tennessee State Collaborative on Reforming Education — provided insight into the United States’ response to the coronavirus pandemic.

In early March, Smith was asked by the White House to support the federal coronavirus pandemic response. Over the last 12 weeks, he has worked on various projects focused on scaling up coronavirus testing, improving the personal protective equipment (PPE) supply chain, and more. He recently worked with several agencies to develop the ongoing pandemic response structure for summer and fall.

“It’s really important we stay vigilant,” Smith said. “Preparing for the coming months is important work the Department of Health and Human Services, FEMA and the White House is currently working on. Developing a vaccine, therapeutics and diagnostics are all really important components of this work.”

Smith went on to explain the private sector played a critical role in the pandemic response. “When you realize how the U.S. economy works, the important role of the private sector, and the timeline we were on, it became obvious we had to leverage the private sector. We needed to bring critical supplies from overseas and distribute them to thousands of hospitals, and partnering with private manufacturers and distributors was the only way it was possible.”

Smith said a number of companies “stepped up in an amazing way” and were helpful in this effort. For example, Nashville companies such as HCA and LifePoint participated in a ventilator loan program to support COVID-19 hotspots with additional resources. Nashville CEOs offered guidance and support, and another Nashville native, HealthTrust Europe CEO Dennis Robb, joined the team in Washington D.C. to aid distribution.

Looking ahead at the possibility of a second wave of the coronavirus, Smith feels the country is better prepared than we were in the spring. The current focuses of the preparation include improving surveillance and outbreak detection, developing a vaccine, and developing therapeutics for treatment.

Smith said Operation Warp Speed has a very aggressive timeline for producing a vaccine, and a number of candidates are already undergoing at-risk manufacturing, meaning that while the vaccines are going through phase two or three of clinical trials, the doses are already being manufactured to ensure they are ready to distribute if the trials are successful.

“As we approach fall, we’ll have more testing than we have today, we’ll be able to monitor and deploy teams to states and cities faster, and hopefully some of these therapeutics and potential vaccines will come available. I think we’ll be well prepared, but again, remaining vigilant is important,” Smith said.

An audience member asked Smith to describe what the “new normal” will look like for health care providers and what innovations will come out of the pandemic. He identified telehealth as the “most likely to stick” but said providers will need to determine if telehealth should be used as a replacement for existing services or an addition to care. Additionally, CMS eased scope of practice billing and regulatory restrictions during the pandemic, and Smith hopes some of those changes will remain. Many restrictions exist at the state level rather than the federal level, but CMS is thoughtfully considering and exploring which flexibilities can remain in place.

In regard to payment and care delivery models, Smith reaffirmed the Center for Medicare & Medicaid Innovation is still committed to value-based care, even amidst the coronavirus pandemic.

“Ten years ago when the Innovation Center was created, the hope was that as these models were rolled out – costs would come down and value and quality would go up – but participants in these models and the government are learning that value-based care is hard. What’s encouraging is people are very united around the importance of the work. The desire to move forward shows the broad commitment to value-based care,” Smith said. “We have to figure how to make value-based models sustainable. Payers and providers have said that if we can show the models deliver savings and higher quality, they will join us. I feel confident if we can drive outcomes through CMMI, others will follow.”

The Nashville Health Care Council will continue to offer relevant and timely virtual events during the COVID-19 pandemic. Register now for the next installment in the Council’s virtual series, “Health Care Brass Tacks,” on Tuesday, June 23, at 11:30 a.m. Watch for more information on upcoming programs at healthcarecouncil.com.