CMMI's Fowler on health policy's 'stubborn challenge,' her ties to medicine

CMMI’s Fowler on health policy’s ‘stubborn challenge,’ her ties to medicine

WASHINGTON — Liz Fowler’s career just came full circle: last March, she took charge of the health policy innovation center she crafted as a congressional staffer more than 12 years ago.

Fowler is an institution in the Washington health policy scene, having worked in Congress, in the Obama White House, in the private sector, in a private foundation, and now in the Biden administration. Her work, she told STAT in an interview, was inspired by her family ties to health care policy. She was included in the inaugural STATUS List recognizing standout individuals in health, medicine, and science.

Her current charge at the Center for Medicare and Medicaid Innovation is delivering on one of the most stubborn challenges in US health care right now: fixing how the government pays for health care services. Most experiments so far have failed, and Fowler sees the challenge as one of the great unfinished goals of the Affordable Care Act.

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You’ve dedicated your decades-long career to health care. What was your inspiration to make that choice?

Liz Fowler Courtesy Elizabeth Fowler

My interest and my inspiration for getting into health care was my father, who was a doctor. My grandfather was a doctor. So we had medicine in our household and so growing up I thought I wanted to be a doctor, and basically all through high school. And then starting out in college, I took a policy class as a sophomore, and it was on health care systems at the University of Pennsylvania. And the professor said that the US was the only country in the developed world without a national health system. And that sounded a lot more interesting than practicing medicine.

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Why did you want to come back to government? Can you tell us about the moment you got the ask?

I think government service is a calling, and I probably could have gone happily along and stayed in the private sector, but I really felt like there were a lot of tough issues that still needed to be addressed, challenges that needed to be met in the Biden administration.

President Biden was vice president when I worked in the Obama administration, and I knew that he was someone who really wanted to take on health care and make sure that we made our system better for patients and Medicare and Medicaid beneficiaries.

I have to say that CMMI seemed like the perfect opportunity. Because I had worked on the legislative language that created CMMI and knew what its purpose and mission was. I knew that it could really be a catalyst for changing the system, and I knew what tools it had in its toolbox.

It’s only a bonus that I get to work with a lot of people I call friends, like our Administrator Chiquita Brooks-LaSure and the Principal Deputy Administrator Jon Blum. These are people that I’ve known for most of my career and I think to have that relationship and that sort of level of trust and understanding with the people you work most closely with is an opportunity not to be missed.

It’s been 12 years since the Affordable Care Act passed. What is the next phase of the health reform effort?

I think the next phase of health reform is covering the remaining uninsured and lowering health care costs, which were the sort of twin goals of the ACA 12 years ago. I am really pleased that 31 million Americans have coverage through Medicaid or marketplace plans. That’s so significant. … I think Congress has a role to play in helping deliver that promise, but CMMI can think about the affordability angle and making sure that we have a health system that’s sustainable and affordable to people.

Why is health equity personally important to you?

My grandmother was a non-English-speaking dual-eligible in Texas, and she had a number of health conditions that weren’t very well-managed. Coordinating her care required my mom, my aunts, and my uncles. They had to help her navigate the health system, and to go with her to all of her appointments to help translate for her doctors.

And as I think about health equity, like some of the models that we’re testing to improve care delivery, they could have helped better coordinate her care and been more responsive to her specific needs.

When we think about meeting patients where they are and making sure that we’re reflecting the values ​​of the patients, being able to think about that through an equity lens is what inspires me.

How are you working to create a sense of community at CMMI?

When I joined the Innovation Center in March of last year, we were still operating 100% remotely. And you can imagine in the year that I’ve been here, I’ve only met a fraction of our team in person. So creating a sense of community in a virtual environment — and I’m sure this has been the case for many people across the country — has been challenging.

We’ve tried to create a sense of community by holding monthly spirit team events. We dedicate meeting time to acknowledge accomplishments, whether that be launching a new model or thinking about a solution to a methodological question, or improving our processes. I have a virtual lunch every month where I get the opportunity to spend time with a handful of staff to get to know them better and their interests.

I feel really fortunate to be in this role. It’s a team that works really hard and cares deeply about trying to make a distinct difference.

What health care policy challenge keeps you up at night?

It’s not one specific small, narrow issue. One of the most stubborn health care policy issues is really thinking about aligning payment incentives and driving value. Really moving the system from volume to value is essentially why I took this job, because that is a very stubborn challenge.

The rationale behind creating the Innovation Center was because there weren’t a lot of solutions out there to bend the cost curve. Now, building on that momentum, we’ve thrown a lot of spaghetti against the wall. We’ve launched more than 50 Alternative Payment Models, but only four models have met that sort of statutory standards to be expanded. … I think we’ve collectively come to realize that transitioning to value is a marathon and not a sprint.

This interview has been lightly edited for length.

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