Richard Gilfillan, MD, will be the new Acting Director of the new Center for Medicare and Medicaid Innovation (“CMI,” or “Innovation Center”) at the Centers for Medicare and Medicaid Services (CMS), CMS Administrator Don Berwick announced today. Gilfillan currently directs CMS’ performance-based payment policy staff.
The Affordable Care Act gives the Innovation Center the crucial mission of testing “innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing quality of care.” A CMS spokesperson said that Gilfillan was named in an acting capacity to quickly fill a role vital to the implementation of health reform; the spokesperson said he could not at this point provide a timetable for filling the position on a permanent basis.
“As the Acting Director of CMI, Rick will be working closely with the CMS Deputy group and me to develop and implement innovative programs that will help improve and update the nation’s health care delivery systems under the provisions of the Affordable Care Act,” Berwick wrote in an email message to CMS staffers.
Gilfillan accepted the job directing CMS’ performance-based payment policy staff in August. Before joining CMS, Gilfillan was a consultant for Geisinger Consulting Services, where, Berwick wrote, “he provided consulting services to health care systems and payer organizations regarding the design and implementation of innovative care delivery and financing programs including accountable care organizations, patient-centered medical homes and bundled payment systems.”
From 2005 to 2009, Gilfillan was president and CEO of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System, a large integrated health system with 750 physicians, three hospitals, and 12,000 employees. There, Berwick wrote, “he helped design a bundled payment, episode of care reimbursement system, ProvenCare, for acute surgical and medical care that rewards providers for providing high quality outcomes. He also directed the development of Geisinger’s ProvenHealth Navigator medical home model and was a member of Geisinger’s CMS Physician Group Practice Demonstration Project team.” Some of the articles Health Affairs has published regarding the Innovation Center and Geisinger are listed at the end of this post.
At a June 8 Health Affairs briefing, David Cutler spelled out how important the Innovation Center’s role will be to the overall success of health reform. If health reform succeeds in “bending the cost curve,” the United States “will be able to afford the commitments we’ve made under the legislation, as well as the commitments that were already in place through Medicare and Medicaid. If we can not bend the cost curve, then not only will the new commitments we’ve made fail, but the older commitments to Medicare and Medicaid and a variety of other programs will fail as well,” said Cutler, a Harvard University economist who advised the Obama Administration during the development of the Affordable Care Act.
From 2001 to 2005, Gilfillan was the senior vice president for national network management of Coventry Health Care, and from 1989 to 2000 he held several positions at Independence Blue Cross. Gilfillan began his career as a family practice physician, and he was the medical director of two primary care group practices.
A Health Affairs Reading List
Innovation Center (CMI)
Stephen M. Shortell, Lawrence P. Casalino, and Elliott S. Fisher
“How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations”
Health Affairs, July 2010; 29(7): 1293-1298
Stuart Guterman, Karen Davis, Kristof Stremikis, and Heather Drake
“Innovation In Medicare And Medicaid Will Be Central To Health Reform’s Success”
Health Affairs, June 2010; 29(6): 1188-1193
Michael S. Barr, Sandra M. Foote, Randall Krakauer, and Patrick H. Mattingly
“Lessons For The New CMS Innovation Center From The Medicare Health Support Program”
Health Affairs, July 2010; 29(7): 1305-1309
“Geisinger Chief Glenn Steele: Seizing Health Reform’s Potential To Build A Superior System”
Health Affairs, June 2010; 29(6): 1200-1207
Ronald A. Paulus, Karen Davis, and Glenn D. Steele
“Continuous Innovation In Health Care: Implications Of The Geisinger Experience”
Health Affairs, September/October 2008; 27(5): 1235-1245
James M. Walker and Pascale Carayon
“From Tasks To Processes: The Case For Changing Health Information Technology To Improve Health Care”
Health Affairs, March/April 2009; 28(2): 467-477