Day 2, Part 3: PTAC Public Meeting | Public Comments & Committee Discussion | 9.9.2025 | 8/8

Welcome back. At this time we'll have our public comment period. Is there anyone here with us today who would like to give us a three-minute public comment? At present we had one person who signed up for a public comment. Mr. Brian Scarpelli who's the Executive Director of Connected Health Initiative. We'll wait to see if Brian is on. Not hearing from Brian and hearing none in this public space, this is the end of the public comment period. Now the committee will discuss everything we learned yesterday and today. Based on this public meeting PTAC will submit a report to the Secretary of HHS with our comments and recommendations on using data and health information technology to transparently empower consumers and support providers. Committee members please refer to the potential topics for deliberation document on the table in front of you during this discussion. If you have a comment please flip your name tent up or for our virtual committee members please raise your hand in zoom. Who would like to start? Lee? Thank you Jenny. So Larry Kosinski sent in some written comments since he was unable to attend this portion of the meeting. So his thoughts are as follows. One he says he was very impressed with Mendel Erlandson's presentation. Loved his concept of care coordination management as being the middle earth, the important middle part in the process. Build the brain to amplify the heart is a powerful statement around making AI more human. In our world of value-based care it would be great for AI to build the neural pathways to build anticipatory care management and make it more automated and less labor-intensive. There is still an issue with communication from care coordinators, care managers to providers. We certainly know that to be true. There is an opportunity to leverage ambient recording to generate AI solutions around care management and he thought that was a powerful opportunity. In the second session Larry's comments were focused on the business model of the practice in creating value-based care solutions. We've heard this over and over again over the last you know several years. Risk coding is a problem the practices are not doing a good enough job coding for risk and we clearly heard they are uncertain what the value in it is for them. Proactive care solutions need to be first dollar and not incur a copay. This could be a waiver option for us to suggest around the CCM and TCM codes. Those were Larry's comments. Any other committee members want to comment on the last two days? Go ahead Jay. It was very interesting about the AI applications that may be possible in health care especially in physician reimbursement models and I think it's something that our committee should seriously consider recommending to the Secretary. You know that we really kind of open it up to non-traditional providers per se to bring us AI models and I think it's worth exploring. Thank you Jay. Krishna? It's nice to the copay thing was a good, interesting to see some of these simple barriers that come the way of broader value-based care, broader patient empowerment engagement. So I think certainly an opportunity for us to spend some time just like surfacing up those sort of like smaller barriers that we can recommend to be revisited either in the context of a waiver or just otherwise that design benefit design certain improvements as well so that was a good sort of takeaway for us. Two was Jay's point of the AI stuff too. I think that feels like there's worth experimenting in the context of incentivizing and making sure there is experimentation being done in the AI space so setting aside some incentives to further AI care coordination or some way of like creating more more capacity for the health care system because I know it's a sort of broader provider shortages an issue anyways for us and so a way for us to responsibly test AI by incentivizing I think this might be worth you know what sort of we're making that recommendation to us. Lindsey. Yeah thanks Janine. Plus three I guess the issue of removing cost sharing barriers or coinsurance barriers for care coordination or things I think we've heard this in multiple meetings it continues to get shared again in the context of new tools and data and AI. So not a surprise but again I agree with Krishna maybe there's some low-hanging fruit in terms of more explicit recommendations for waivers for existing programs to just remove that barrier. I think two things that were unanswered but raised in the conversation here is just the amount of potential new data and tools that are about to be introduced into the space and wanting to be paid for and a real lack of metrics and success success measures. So identifying a gap as we think about potential payment we're gonna need to think about how we measure success without just introducing more process measures to further glut the reporting and bone burden of documentation. I think we also heard a little bit yesterday around just as we need to be thoughtful that payment can keep up with the volume of things that are about to hit primary care doctors in particular but physicians of all specialties and we just really need to be thinking as well you know moving a total cost of care payment models might be the goal if we don't come up with interim things we're gonna drown our primary care workforce in the amount of data and things to come. So I think really getting more people on the team involved in care coordination with all this increased data AI maybe is one part of that team. I mean I think the final piece would be as we as we ask for patients and providers to be more comfortable with engaging in alternative data sources. I think we have to be thinking about what are the guard rails to ensure that data isn't used to deny payment. So I think with the potential I don't know that we have heard really sufficient guardrails to ensure that people who are surfacing and looking at this amount of data don't also have that used against them to say something wasn't done or a metric was not made. Walter. I was quite struck by how different the content of day two today was compared to day one. I felt like day one was much more about empowering consumers and today we spoke about data and health information technology more to support providers and so I felt that was a good mix. I see a lot of potential in using better using data better to support providers. The whole AI panel discussion was fascinating and I think shows how rapidly that technology is changing the very practice of medicine. And it also I was impressed with organizations like Harbor Health who is using data to help patients make the right choices especially with kind of steering them to higher quality more efficient providers through the use of lower or no copays as an example. So there's a lot of promise there in terms of using data and health information technology to support providers. In terms of empowering consumers I came in as I said yesterday as a skeptic and I leave as a skeptic I think empowering patients activating them without making them accountable in some way shape or form in their own health care might be good but not sufficient to make this a worthwhile effort and total cost of care models. And a large part of that is because we don't have much evidence said that empowering patients especially in the Medicare population especially in the seriously ill that drive a large part of Medicare spending that this really affects outcomes. And so I think there's a lot of room to develop more studies create the evidence base that supports patient empowerment and engagement really matters to improving outcomes both quality and cost outcomes. And I think there's a lot of opportunity for CMMI to maybe embed some of these ideas these technologies into payment models to test them and and see if they actually work to achieve the desired outcomes. Thank you. Josh did you want to weigh in? Yeah I really appreciate the last two days has my has my gears turning on a number of things. I think integrating a little bit of what I mentioned yesterday with some things we heard today and I think some high-level takeaways I think first I think innovation is welcome and good but really should be purpose-driven. I think data and technology and what we can do really should ideally serve the public good and that interest. And while I think there are many stakeholders you know value for taxpayers beneficiaries really the public program should I think take precedence over enriching private interests. I think that should be front and center. Second I think trade-offs as I mentioned before I think are real and have to be navigated and not ignored. And so you know personalization has to be balanced with system this speed balance of safety novelty and equity and I think you know we should just be explicit in our choices around that. I really like to start the last two days about thinking about real scalable solutions. I heard a lot of we should. I think it's a great place to begin. I'd love as other committee members have noted to kind of get to kind of what are we doing now what are we learning. So I look forward to more of that in the future. I would just caution us to be a little bit hype aware and evidence-based. I think lots of about the potential of prediction ML AI etc but I think it's fair to say at the aggregate level many use case benefits are stated perhaps overstated. Monitoring is relatively limited and the unintended consequences of any technology are real. I think we need to remember that. Final couple things quickly I think just addressing the economics of change you know the silos that some of our assemblies talked about we're not just technical they reflect business models and structures. So I think breaking them down has consequences. Some are obvious some are less so and I think we need to acknowledge and manage those. And then you know I was reflecting on the charge of us as a committee thinking about position focused payment models and I think you know one of the things that I'm reflecting on is not everything in every program needs direct payment and this reflects other people's comments about how are we going to pay for all this and how would we do it. Reflects comments about how maybe there's not any perfect way of changing exchanging money across hands but if you think about Medicare as an example most of the things covered under Medicare are covered under bundled services whether that's the inpatient prospective payment system outpatient system etc. We don't parcel out every single thing into code or a discreet service or coverage determination and I think that's probably for the better. So as I reflect on some of the comments from today you know it makes me wonder kind of you know where are the places we should kind of artfully not to do anything related to payment for some of these things. If the business cases and the economics are as real as some of our SMEs are suggesting there shouldn't be necessarily that motivation to do that so I would just be cautious because otherwise I think we could run into this risk of kind of doing more to do more and part of us finding balances to do less strategically and to do more in other places so thanks. Thank you Josh. Lee did you have any comments? Appreciate all those comments and agree. I was struck at times today that regarding AI and advanced data systems we were hearing essentially the plea that use it made me go back to my systems theory training about the whole point is to make it easier to do the right thing and harder to do the wrong thing and make make it so there's enough safety built a system you almost can't do the wrong thing right without breaking glass and so it's I'm gonna be the third person to mention it but I was struck by we've been talking for ever since the codes were created about about the barrier to patients and doctors to do the right thing of the copays in the CCM the TCM and the collaborative psychiatric care management codes so again I think that's a perfect opportunity for CMS in its in its waiver power or model design to remove those barriers to getting higher value care. Heard a strain today that hasn't been picked up quite yet about focusing in on some of the supplemental benefits in Medicaid and in a and emphasizing the benefits that are proven increased value and health outcomes and systematically reduce those or take off table those that are mainly about marketing. I mean I know in MA it's an it's a private company's money to spend as they choose but it's still within program design parameters and for Medicaid where you're very directly spending taxpayer money even though it's a supplemental value add benefit it should be for something that actually adds value not just adds marketing or splash so certainly we heard food benefits transportation benefits hearing aid benefits are key and actually are almost never included in Medicaid programs so I would focus in on those for sure and then on AI you know really jazzed and encouraged by the conversation love to hear about stories of innovation I was struck at multiple times that the the AI innovation world is racing about racing ahead far far faster than our regulatory compliance and legal framework can keep up with and that perhaps the most conservative force known demand is the compliance attorney team in any modern health system and so I think that's a good opportunity for again through its regulatory powers and or waivers and or model design for CMS to offer some perhaps the MSSP but just to offer some safe harbors for use of the AI tools that are clearly driving value and lowering costs and taking a step further to say if if it's clearly increasing value and quality of care why why do we not rush to make that make that the expectation as opposed to that's that's the innovators let's let's try to tip from the early adoption innovators as quickly as we can to mainstream adoption and that there might be a role for a model to overtly incentivize use of these and then that would allow some may to be testing from those who have have adopted those who have not and prove its value even better that's what I have thank you and I have just a couple of things to add to the entire committee's input I think the power of AI see is to be seen in health care I mean a health care is one of those places where I think it holds the most promise particularly because it has computational power to tie in data sets and I think one of the things that came in in the conversations was the ability for personalization whether it was yesterday or today through care met the care management platforms that level of personalization that allows us to deliver sort of that human loop care is where I believe there's the greatest promise the other thing that hasn't been mentioned that I was struck by was the identity management that came in and how the ability to actually have appropriate identity management allows for patient consent and allows for it to be seamless through multiple environments and that's something that can be done today so we don't have to wait for that we don't have to worry about come you know we do have to worry about compliance but we don't have to there isn't a proof point we know that works because it's been done in so many other situations so I think that's one thing that we should stress I want to double-click on what Lindsay said about the inadvertent use of this computational power and the ability to tie various data sets together while they're powerful in personalization we do have to make sure that there are guardrails built into the system to not inadvertently create more disparity in benefits or create more disparity in outcomes as well as be used as a power to deny payment for things that meritoriously deserve payment I think my favorite line was you know that incentives to use for the use of ethical and meaningful use in AI is maybe a potential that can increase adoption in a rational way that Josh I believe you have another comment yes I if I if we have time for if the co-chairs okay I think you know I was reflecting on actually just these last few comments and I think again it's important I think Lee yesterday made a really important comment about you know stagnant reimbursement for physicians and you know how payment physicians and practices obviously can drive innovation and yet this comment about the copay for something like CCM or other things highlights the point that increasing payment increases the burden to patients as well and so we're not getting away from the end by in turn taxpayers and beneficiaries so we're not getting away from that in any of these kind of conversations the other thing I really take you know Cheney your point really well and I'm struck with kind of this idea that one of the driving motivations for groups like ours and others is that we believe there's waste and redundancy in the system and so you would imagine in an ideal world like the day would help us identify those right that that we should stop paying for certain things but then we also want to start paying for other things and so I think I would just you know encourage us the committee to kind of think about that reflect on you know what our partners at CMMI and other places are doing when they're judged the things like cost savings and stable quality or stable cost and increased quality we urgently need data around these things but as you try to solve the one problem I think we can potentially create you know issues with the other and I think this copay discussion is a great example and I think data to you know determine coverage is determinations is another I don't know those are purely good or bad things they're both thank you Josh anybody else have any additional comments so barring none I'd like to thank all of our committee members for sharing your very valuable comments across this two-day meeting and your time in spending spending the day here the two days here before closing I'd also like to check with the ASPE staff to see if there any clarifying questions for us Marsha Steve do you have any questions or comments I don't thank you so much it was a very good conference thank you yes I think it was a great meeting and I think support staff we have the responsibility now take all this information and fit it in the the framework that Krishna presented yesterday morning in order to make a good report to the secretary thank you and prior to closing I'd like to mention a committee member who was unable to be here today but this is his last formal meeting Jim Walton who's served on P tech with us we will miss him and we wish him well in his endeavors and Jim's been an incredibly valuable voice on this committee speaking for many parts of the health care system that are often overlooked or marginalized so thank you to Jim I want to thank everyone for participating today our session experts my P tech colleagues and those listening in we explored many different topics using data and health information technology to transparently empower consumers and support providers special thanks to my colleagues on P tech there was a lot of information packed into these two days and I appreciate your active participation and thoughtful comments the committee will work to issue a report to the secretary with our recommendations from this public meeting and with that one final thank you to the committee and session experts for joining us to make this a memorable and informative P tech public meeting this meeting is adjourned produced by the US Department of Health and Human Services