Abe Sutton (@AbeSutton) profile picture
Joined March 2012
Photo by Abe Sutton (@AbeSutton)Photo by Abe Sutton (@AbeSutton)
Abe Sutton retweeted
I am endorsing Mike Rogers for the United States Senate today.
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Prior authorization requests in WISeR focus on a small, targeted set of services that are especially vulnerable to fraud, waste, and abuse—not every treatment. Learn more: go.cms.gov/WISeR
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"At the end of the day, WISeR is about making sure people with Medicare get treatments that improve their health outcomes and do no harm." — CMS Innovation Center Director Abe Sutton Learn more: go.cms.gov/WISeR
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Abe Sutton retweeted
CMS is inviting organizations to apply for the MAHA ELEVATE Model! The @CMSinnovates' MAHA ELEVATE model is the first Innovation Center model to focus on holistic, patient-centered functional or lifestyle medicine approaches that include nutritional, physical activity interventions, psychological and/or self-care strategies to address the whole person rather than individual disease. It’s what the MAHA Movement is all about! We’ll award ~$100 million total to fund up to 30 proposals with evidence-based functional and lifestyle medicine interventions so more people with Original Medicare can join these programs. Learn more: cms.gov/priorities/innovatio…
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Abe Sutton retweeted
At CMS, we’re laser focused on helping Americans be healthy by making it easier to access technology-supported care. So today, we brought together major health plans to sign the ACCESS Payer Pledge – promising greater consistency across Medicare, Medicaid and commercial payers, and making digital health technologies more accessible. Learn more: go.cms.gov/ACCESS
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CMS Administrator Dr. Oz commented on the launch of TrumpRX, a direct-to-consumer (DTC) platform selling drugs at discounted prices under the most-favored-nations (MFN) model. According to the CMS administrator, “These are U.S. government-negotiated Most Favored Nation prices. It is an elegant solution to the problem facing so many Americans... with 90% discounts, we have an ability now to completely reset expectations for the American people.” Also commenting on TrumpRX, FDA Commissioner Dr. Makary said, “TrumpRX is the beginning of a new chapter in American health care where—for the first time—you can buy the drug from those who make it… The amount of money games that go on with health care’s middlemen… are unbelievable.” According to HHS General Counsel Mike Stuart, “Based on a review of the applicable facts, earlier today the HHS Office of the General Counsel referred Hims & Hers Health, Inc. (‘Hims’) to the Department of Justice for investigation for potential violations by Hims of the Federal Food, Drug, and Cosmetic Act and applicable Title 18 provisions.” Secretary Kennedy commented on a meeting he held with Tennessee Governor Lee. According to the HHS Secretary, “This week, I met with Governor Bill Lee of Tennessee, a key partner in the MAHA movement. Tennessee is leading the way by banning Red 40 from school meals, strengthening fluoride transparency in public water systems, limiting student cell phone use in schools, and requesting a SNAP waiver that restricts the purchase of sugary drinks and candy. Together, we will Make America Healthy Again.” According to a recent study shared by the NIH, “Researchers found that prescription stimulants for ADHD act on brain networks that control wakefulness and reward, but not attention as previously thought. The study suggests that stimulants and additional sleep affect the brain in similar ways, and that getting enough sleep could help in managing [ADHD symptoms].”
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Abe Sutton retweeted
Go to TrumpRX.gov. This is our effort to make all those drug negotiation prices available to you.
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Obamacare proved that one-size-fits-all health insurance is a recipe for skyrocketing costs. Exchange premiums are set to surge by 18% next year due to the unsustainable structure Obamacare imposed. For too many families, health care now exceeds housing as a budget item. While Biden’s answer to this was more taxpayer money shoveled out without strategic planning in an unsustainable manner that is now set to expire, we know the solution is choice and competition to serve people. We are giving Americans new flexibility to choose the plan that is right for them. We trust the American people and are committed to affordable options. @CMSGov
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Estimates for the cost of unnecessary or ineffective healthcare interventions range from 10-30% of total spend. Any serious effort to reduce costs and improve care must address this. The WISeR model proposed by CMS will face pushback, but is an important step forward. Many procedures, tests, and drugs have no clinical benefit, but almost all interventions have risks and side effects. A well-run health system protects patients from unnecessary and even harmful services and protects the taxpayer and patient from unnecessary spending. There’s a place for targeted utilization review that occurs before the unnecessary service is delivered and the claim is paid. Some Medicare Advantage plans arguably overuse prior authorization, creating unnecessary friction for patients and providers. Meanwhile traditional Medicare rarely applies it, paying for all care regardless of benefit. The WISeR model is a small pilot by CMS to add prepayment review aided by a mix of technology and clinicians for select low-value services in 6 states. If anything, I think it moves too cautiously, but CMS is right to be careful to ensure the incentives and guardrails are set properly. While prior auth in MA has left many clinicians and patients uneasy, the WISer model is designed to improve health outcomes and reduce costs without imposing needless burdens on providers. It's a smart reform and deserves support.
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Abe Sutton retweeted
In this episode of The ACO Show, we welcome @AbeSutton, Director of @CMSinnovates (CMMI) and @Farzad_MD, Aledade co-founder and CEO, to discuss the new strategic framework shaping the future of #Medicare innovation. bit.ly/3ISZzql @CMSGov @dc_cavanaugh
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Newly proposed Ambulatory Specialty Model (ASM) would promote prevention and upstream management of 2 chronic conditions, heart failure and lower back pain. Learn how ASM would incentivize specialists to improve patient health at lower cost: go.cms.gov/ASM
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New model from @CMSinnovates dropped on Friday. WISeR - Waste and Inappropriate Service Reduction Hear all about it directly from @AbeSutton
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Medicare is looking for tech vendors that can help root out the $10Bs+ of wasteful spending each year. If you can help, and care about reducing the federal deficit, this is a very big lever. Participants are eligible for a percentage of the improper spending they eliminate.
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A brief thread on @cmsinnovates new model called WiSER. This model will test a highly targeted and more streamlined approach to payor review of medical services in insurance by trying it in Traditional Medicare. cms.gov/priorities/innovatio…. /1
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Abe Sutton retweeted
Today, the CMS Innovation Center launched our new strategy to protect federal taxpayers and Make America Healthy Again through: 1) evidence-based prevention 2) patient empowerment 3) choice and competition Read more: go.cms.gov/46ToHDX. MAHA
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WOW this story. I've written about issues with UNOS/organ transplants in the past, but this report is explosive.
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Over 40,000 people die of end‐stage kidney disease each year. Many of those deaths could be prevented. @coachbuckethead, @joshmorrison of @waitlistzero, @aei’s @slsatel & Alan Viard, @AbeSutton, and @Mario_Macis share ideas to increase organ donation… cato.org/regulation/summer-2…
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An unfortunate result of today's EO is that the President ended the requirement for a biannual report on federal & state policies that raise health care prices & lower quality by restricting choice and competition. So, this might be the only such report: hhs.gov/sites/default/files/…
And the reason we did the Health Care Choice and Competition report was so Republicans could have a roadmap for health reform built on improving the broken incentives that are everywhere in our health sector. hhs.gov/sites/default/files/…
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New from @AbeSutton: Issuing the Most Favored Nation Interim Final Rule Was a Mistake blog.petrieflom.law.harvard.…
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