Hi, everyone. Welcome to our webinar today. I'm Helen Burstyn, the CEO of CMSS, and we're so pleased that so many of you signed up to join us for this important update from our colleagues at CMMI. We've been really happy to be working with the CMMI team, worked closely over the last couple of months, really to think about how we could share and collaborate and provide some input from specialty societies on sort of current and future models, and we're really excited that CMMI has offered, really, this greater transparency for us as we think about how we can work together on their evolving strategy related to accountable care, specifically for specialists, as well as specialist integration in primary care. So on today's call, I am delighted that we are joined by three of the leaders at CMMI. Susanna Bernheim is the Chief Quality Officer and the Acting Chief Medical Officer of CMMI, formerly at Yale Core, so has a long history in the quality measurement space. Jake Quinton is a Medical Officer at CMMI and has been leading a lot of the specialty work, and then Rachel Roiland is the Clinical Nurse Specialist at CMMI, and again, I think you'll have just a great opportunity here. They're going to give a brief overview of sort of where they are, their five-year initiative, their thinking about where they are in terms of specialty models, and we will have a significant amount of time for your feedback. So with that, I'm going to turn it over to Susanna and her team. Thank you. Thank you, Helen, and thank you, everybody, for joining. I see we've got a lot of people on this call, and I'm thrilled to get a chance to talk with all of you and really appreciate CMS bringing this together. If you go to the next slide, I'm going to say really just a word about why we're here and then let my colleagues take it over. I've been at the Innovation Center for about a year now, serving as the Chief Quality Officer and, as Helen said, now the Acting Chief Medical Officer, and thinking a lot about our quality measurement strategy and partnering with our groups that are developing the models to think about the quality measurement strategy, and we really want to make sure that there's transparency of the thoughtful strategy that our CCMG group has put together related to advancing accountable care focused on specialists and specialty integration. So most of today we'll be presenting that with updates from things that have been publicly presented to the progress that we've made, but then also this is a starting point for us to engage in ongoing discussions with all of you regarding the specialty measurement landscape and where there are gaps, where there are important measures that are being used, where there are priority measures that we should be paying attention to. So this is really those two things are our goal, and we've started a series of conversations with Helen and her team that we're going to continue, and your input is going to be really important to feed into that as we think about the measurement landscape together. We have a number of people, those who Helen introduced, but also other leadership from the Innovation Center here, so we've got lots of people to answer your questions, and as Helen said, we're going to just do the next slide. We're going to give a very brief overview. Jake will provide this of the Innovation Center's strategy refresh, and then Rachel will be sharing our specialty strategy, and then we'll leave lots of time to hear your questions, hear your thoughts, hear your recommendations, and talk a little bit more. So thank you so much for joining us. Thanks so much, Susanna, and I think one more slide, please. I'm Jake Quinton. I'm a primary care doc. I see patients on Fridays and have been working at the Innovation Center for the last three years on both specialty models and then more recently focusing on the quality strategies. I want to note that my time in medical training has been significantly influenced and I've been deeply grateful for leaders in organized medicine that have mentored me along the way, including those on this call today. So a real privilege to get to speak to you all. With regard to the CMS strategy refresh, at the beginning of the Biden administration in 2021, CMMI announced our new strategic direction for the next 10 years. Many of you have seen the white paper that I'm about to show in the chat, but there's certainly, and this is a figure that's kind of our guiding principles for how we organize our work in moving into the next decade of the Innovation Center. There's five pillars and all of these five pillars sum together to help us build the health system that is going to deliver equitable outcomes through high quality, affordable person-centered care, and each of those words is really important to us. Our five pillars, as I'm sure you've heard in the last three years, but just to say them out loud, are driving accountable care. We have a goal of all Medicare beneficiaries and traditional Medicare being in accountable relationships for cost and quality by 2030. Advancing health equity, which to us means throughout our alternate payment model design, implementation and evaluation, searching for ways to improve health equity and reduce disparities. Third, supporting innovation, where we are, we call ourselves the Innovation Center, but this particularly means innovations around person-centered care, incorporating the patient experience and particularly patient-reported outcomes throughout our measurement strategies. Of course, we're statutorily mandated to expand models only if they either improve quality and hold cost neutral or if they lead to savings and hold quality neutral. So affordability is key for our work. And fifth, partnering to achieve system transformation. We know that Medicare is one payer in a mix, and while we certainly consider ourselves leaders, we acknowledge that for models to be successful, we need to be aligning to the other payers that matter for both our patients and for the clinicians that practice in our clinics. So those are our five pillars for the new strategy. I think what is probably more salient for this conversation is the next slide, which comes from our one-year update to this strategic refresh. This one-year update, and certainly we're overdue for another update and hope to have another to share soon, but this is a pipeline slide for how we organize our work moving forward. The strategy roadmap, I want to highlight the Health Care Payment Learning and Action Network, or LAN, is a great opportunity to participate in webinars and learn from other leaders across health care transformation and delivery. We have hosted a series of listening sessions and webinars from understanding better the benefits to your patient perspective, new model developments, and cross-model issues such as equity. And you'll see here a slightly dated 2022 pipeline where we were still very proud to announce ACO REACH, EOM, an extension of the VPCIA or the Bundled Payments for Care Improvement Model that Rachel's going to dive into a little bit further. And then in 2023 and 2024, when this slide was created, we would say advanced primary care model tests are coming. Now we can say that we were successful in announcing Making Care Primary, a 10-year advanced primary care model that focuses on a progressive design and many of the equity elements we highlighted earlier, as well as some of the first special integration policies that I'm excited for Rachel to review in more detail. And on this slide is a state total cost of care model test, but by that we mean ahead. A new state level model test that's going to be focusing on the lessons learned from the Maryland total cost of care model and transforming states into building in global budgets and pushing some of those savings from those goal budgets for primary care transformation. Incredibly exciting work. When we talk about population and condition specific models, we can now say guide the new dementia model that's been announced by leaders on this call and is going to be transformative in improving care for patients with dementia. And we highlighted the VPCIA in terms of bundled payment models. We mentioned EOM previously and certainly element two of our strategy Rachel can dive into more in terms of where we're going in bundled payments. And we'll say just one other word in terms of prescription drug models. Just I believe last week we announced the cell and gene therapy model in terms of the transforming care and self-therapy. And we have, we've been asked by the president to look into other areas for improving affordability and prescription drugs and where they may fit in perfectly within this framework or may not. We have a couple other models in terms of the innovations in behavioral health and transforming maternal health care. So much work that's happened since the foundation that was laid in the strategy refresh. As you see, looking forward to 2025 and 2029, we're thinking about ACO models that both support primary care and require accountability for total cost of care and outcomes, more bundled payment work to come and as well as further population and condition specific models and salient for this call, the specialty integration models. So this work, there are a series of crosscutting issues in addition to quality, there's health equity, risk adjustment, multi-payer alignment, and we align ourselves to work in teams, both on specific models and then also on these pressing cross model issues. So hope to have an update for this pipeline slide to come in the months ahead, but I'm happy to give this quick update in terms of where we're going with our strategy. And I think the next slide, please. And now I'd like to hand it over to Dr. Rachel Roiland with her depth of expertise and quality and leadership in our specialty strategy. Thanks so much, Jake, as Helen mentioned at the top of the call, I am within the patient care models group at the Innovation Center. And as Susanna mentioned, that is the group that's helping lead the implementation of the Innovation Center specialty care strategy. So I'm really excited today to be here with you all. And I think I have two main goals for my presentation today. One is to provide you all with the latest new information on the progress that we've been making on the strategy. Jake did a great overview, I think sort of highlighting how we've in the past set out sort of specific broad goals that we're trying to reach and have slowly sort of ticked the box on each of those as we have announced new models and new initiatives. And so the specialty strategy is a similar sort of approach about trying to sort of set out these broad level goals and areas of action. And we're working towards implementing specific activities under each of those actions. And so I want to be here today to provide you all with sort of the latest and greatest information available on each of those areas of action. And also, I think I really want to convey and I hope to convey that the work on the strategy has and will continue to evolve. It's not sort of baked and set out to go out into the world. This is a strategy that we're implementing in different phases and sort of different elements are in different areas, are in different stages of development. So the opportunities to collaborate with specialists such as yourself and specialist organizations continue to be available. And we hope to this to be sort of the start of a series of conversations with you all and with CMSS as well. So that's sort of my goal. Those are my two major goals for our conversation today. And so with that, if we go to the next slide. I do believe that most of the audience is familiar with our specialty strategy, but just a quick overview for those who may not be or who just need a refresher. In November of 2022, we published a CMS blog outlining key elements of the center's specialty strategy, and that strategy is really meant to support the delivery of person-centered, value-based specialty care. And this ties back to the strategy refresh that Jake reviewed earlier and the key objectives that we have as part of that strategy refresh, particularly the key objective around driving more accountable care. And the center recognizes that a comprehensive approach to driving more accountable care must include both primary and specialty care, including the integration of those two, and that there's actions that we as a center can take to better support and enable the delivery and integration of those two areas of care. And so the actions that we are aiming to implement are really organized around these four elements of the strategy that are listed here on the slide. The first element is centered on enhancing data transparency around specialty care and is really focused on the sharing and delivery of data that can help inform care delivery-related activities like referrals and care collaborations, as well as potentially informing more formal financial arrangements that may be set up between specialists and other providers or organizations, such as organizations like accountable care organizations. The second element is focused on maintaining the momentum that we've built around acute episode payment models, as well as condition-based models, and it's focused on leveraging lessons we've learned from previous models, like the comprehensive joint replacement models and lessons we continue to learn under the BPCIA model, as well as continuing to consider how we can thoughtfully build out our portfolio of models that are focused on specific conditions. And so Jake mentioned our cancer-focused model, the enhancing oncology model, as well as the new dementia-focused model, the guide model. And so those areas of work really fall under the second element of the strategy. The third element is focused on creating financial incentives within primary care for specialist engagement, and this is really focused on how we can embed within the primary care side of that primary specialty care relationship financial incentives, as well as tools that make it easier for primary and specialty care providers to work together to integrate care, particularly in the ambulatory care setting. And it also does include us considering how we can approach the specialty care side of that relationship and offer more opportunities for specialists to engage in value-based payment arrangements for the care of more longitudinal care management around things like chronic conditions. And then our fourth element is focused on creating financial incentives for specialists to partner with population-based models and to move more into value-based care. And here we're really focused on how we can make more meaningful participation in population-based models more feasible for specialists. And we're particularly interested in how to do this within the context of accountable care organizations. Current elements of some ACO programs, like the quality measures that they use and the attribution algorithms that they implement, may not fully reflect the contributions of specialty care to the care of the beneficiaries under those models. And so we're considering how we might be able to overcome some of those barriers, as well as also better align some of the financial incentives that an ACO has versus a specialist provider. Those might not always align right now as programs are set up. So how can we maybe look at that and make some tweaks to better align those incentives so that participation for specialists in those models is more feasible, you know, just financially from a financial standpoint? So those are the four elements that are really sort of the foundation of our strategy and sort of what we use to organize our work here at the center. You can go to the next slide. Thank you. And so for element one in data transparency, you'll see at the top of the slide a figure kind of charting key milestones along a patient's care journey. And this is a framework we use to help us chart the role specialty care may play in different segments of this journey. And for each element and the rest of the slides, we've kind of highlighted the portion of the patient care journey we think this element and its activities sort of relate the most to. And so you'll see for element one, we see transparency around specialty care performance data really being as important information to have available along the full continuum of the patient's care journey. And our short term goals are really related to how can we facilitate that availability of the data. And so our short term goal is focused on around specialty care performance data and dashboards to participants in our population based models, as well as a long term goal working towards more standardization of definitions around condition based episodes that can help sort of inform the larger field when it comes to episode based care and contracts that may support that care. And really new updates to sort of share around this element are really starting with focusing on toward working toward inclusion, excuse me, the inclusion of specialty care performance data within the data dashboard that's going to be made available to participants and are making care primary model that Jake did a nice overview of earlier. This data will include performance data on specialists within MCP within the MCP participants market area, as well as data on the specialty care delivered specifically to a model participants attributed beneficiaries. And the purpose of this data is to provide information that the MCP participant can use to inform or to consider, at least when making care referral decisions, as well as helping them inform decisions around the specialty care partners they might want to establish under the model. The MCP model does include an opportunity for participants to select specialty care partners that have access to unique MCP tools that I'll get into under element three that can be used to help support robust and coordinated collaboration between the MCP participant and the specialty care provider. And so we see the data that we're providing as being helpful and folks making decisions about who they might want to partner with under those types of relationships. And just a note on this specific element in this update, we know that the sharing of performance data may raise a lot of questions for specialists about what data are you sharing exactly? How are you sharing it? And we really do recognize that it's important that any data we do share, that the recipients of that data have the right context when trying to understand and interpret that data. And so we're working to ensure that the data that is shared with participants and MCP is presented in a meaningful and thoughtful way so they have the appropriate information to appropriately interpret the data that they're having access to. The other update to share under this element is around our soon to start delivery of shadow bundles data to ACOs in the shared savings program and the ACO reach model. These shadow bundles data will follow the BPCIA methodology for constructing episodes around acute care and they're really meant to give ACOs insights into specialist care patterns around acute specialty care and also help the ACO support the management of their beneficiary specialty care needs. And in addition, we think these bundled data will help ACOs that want to help establish sort of financial arrangements with specialists around episode-based care as well. So if we can go to the next slide. Under element two, again this element is focused on acute and condition-based models. Here our short-term goals are focused on extending that BPCIA model for two years which we announced and then have already announced and then also launching new condition-based models with our long-term goal being to test a new mandatory acute model in the future. And new updates to share here are in addition to the enhancing oncology model which is shown on the slide is that guiding an improved dementia experience or guide model that Jake mentioned that was announced this past summer and again focuses on beneficiaries living with dementia and their unpaid caregivers. And just to touch on the quality component of the model given I think that's a key interest of folks here on the call today that model does incorporate a set of performance measures that will be tied to payment and that quality strategy was informed in part by the MVP focused on supportive care for neurodegenerative conditions in an effort to support alignment with sort of reporting requirements that some participants and guide may already have in order to reduce reporting burden for folks. But it also includes two new measures that are going to be under development. One focused on caregiver burden and the other on long-term nursing home utilization. And those are included in an effort to help advance quality measurement in the space of dementia care. We are the innovation center as Jake alluded to and one of our strategic objectives is focus on innovation so we try to find opportunities to innovate in quality where we can in models as well. So just wanted to highlight that. And in addition to the condition focus model the team has also been looking at the development of a mandatory acute episode payment model like as I mentioned earlier. And last summer we did release a request for information to gather feedback on what that model might need to look like and take into consideration. And so we're working through that through the development of that model now. And I just want to point out that that RFI did include a section on quality measurement with specific questions focused on how can we be better at aligning measures across models and payers. How can we work to again reduce reporting burden and also how can we foster greater use of patient reported outcome measures. And so the comments we received on those questions are helping inform the design of this next model. And that model will really aim to incentivize coordination between acute care hospitals and primary care providers following an acute episode. And it's also working to try to include an approach that helps support a complementary relationship between ACOs and hospitals as well. We know that's been a bit of an issue in previous models. Next to the next slide we can talk about element three. All right thank you. And so third element is focused on more of the preventive and chronic disease management portion of the patient journey. And includes a short-term goal of exploring the use of e-consults and enhanced referrals in our models. As well as a long-term goal focused on financial targets for high volume and high-cost conditions that cost specialty care. Excuse me. And so important updates here include going back to the Making Care Primary Model and the specialty care partners that we touched on under Element 1. This model will include new model-specific billing codes that we hope will expand the use of e-consults and will support ongoing communication and coordination between providers in the model. And our aim is to really, with the availability of these codes, along with the provision of data under Element 1, we really hope that that will help advance high-quality specialty care integration into the primary care delivered by our MCP participants. And so, with those MCP innovations sort of underway and in development, we're also exploring developing specialty care models focused on, again, that longitudinal care component, so around chronic conditions in particular, and exploring approaches that may include things like a glide path so that specialists participating in a value-based payment model that's focused on a specific condition, they may gradually, over time, take on more financial risk for the care around those conditions, as well as also looking at ways at how we could potentially innovate off of existing programs and structures that exist today. So, that might be things like the MVP program. So, other ways we can leverage that, look at it, try to see how we can better align it with specialty care needs to sort of incentivize more specialists to participate in value-based payment models for the care of those kind of chronic longitudinal conditions. And then, next slide for Element 4. And then, this fourth element is focused on fostering more aligned partnerships between specialists and population-based models. So, we're really aiming to do this so that the specialty care needs of the beneficiaries cared for under these models can really be addressed, particularly their needs around chronic diseases and acute care management. And this element is admittedly in earlier stages of development, but our goals are really focused on initially looking at accountable care organizations, in particular, and trying to foster specialist engagement in ACOs and exploring how we may need to develop different approaches to specialist engagements depending on the ACO structure. So, perhaps we might need to look at taking different approaches for hospital-led ACOs versus physician-led ACOs, given their differing resources as well as differing sort of financial structures and incentives, as well. There's probably going to need to be unique approaches taken to each to make sure that we're really setting up the stage for meaningful engagement of specialists within each of those types of ACOs. And so, I think that's the update for Element 4, and we can go to the next slide. And so, just to bring this all together, our ultimate aim in this strategy is to really implement actions to help ensure that a beneficiary's specialty needs can be met along this entire continuum of the patient care journey and that the specialist and primary care providers have the tools and necessary financial supports to really deliver care that's high-quality and patient-centered. And so, this figure is just really meant to illustrate how we think these elements together cover different portions of the patient care journey and really try to help us cover that full spectrum again with our different actions under each element. So, if we can go to the next slide. So, with that, I will just wrap us up in terms of presentations and just say thank you so much for your time. And again, we look forward to sort of a continuing dialogue with you all about our work under the strategy, and I'm sure I think that dialogue will start right now with a Q&A section. So, I'll actually turn it back over to Helen, I think, to get us started with that. Well, thank you so much, Rachel, Jake, and Susanna. That was wonderful to kind of get that broad overview. So, we are open to your questions, your comments. Susanna, if there's anything else you want to add after the team has spoken? I know we've got a couple questions queued up for you guys already. Yeah, no, I mean, I thank you, Rachel, and I hope it gave folks some insight into the progress we've made and more information that's coming on that. I think, really, we want to hear from all of you what your questions are. We want to hear what's working well, and we'll do our best to answer things now or bring them back if there's not time. So, why don't you, Helen, you were going to just sort of tee up for us what you were seeing coming through the chat. Yep, definitely. Since Rachel mentioned MVPs, not surprisingly, there is one, a question regarding MVPs. And the question is, CMS is asking societies to create generalized MVPs for specialties, which is in contrast to the models you've talked about here. What types of MVPs should be created, generalized or episodes or condition-based? It's kind of a big question. It is. And I think the specialty team should take it, if you want to, say a little bit you're thinking about that. Sure, I can take a first stab at it. So, I don't think it's going to be one or the other. I think our idea is that there may be specific conditions for which it's appropriate and necessary to develop a model that's specifically focused on that condition. But we also recognize that specialty care is incredibly diversified and there's lots of different approaches that we need to take to try to cover that full breadth to give a variety of specialists an opportunity to participate in our models and our value-based care arrangements. So, I don't think it is an either or. I think the challenge comes in trying to define which models for which conditions and what kind of models are appropriate to cover a greater variety of specialty types in the care that they deliver. So, I don't think it's an either or. It's going to be a both and. Jake or Susanna? I was going to see if Sarah wanted to add anything and I just have one other quick thought. No, please go ahead, Susanna. Thanks. I think you all sit in a really good position to see how we need to think about the balance there, right? Because the more narrow one gets, the more specific one can be, and then you lose a lot of visibility about what's happening in the broader landscape and, quite honestly, sample size issues, right? And the broader we are, the harder it is to get the measures quite right. I mean, obviously, we are not the team that builds the MVPs, just to say that, but we work closely with those colleagues at CMS, and we are thinking a lot about how to build off of those structures that already exist as we advance ambulatory specialty care. So, you know, I think Rachel handled the question perfectly, and we would be happy to hear what you all think are good dividing lines related to that exact question because it's a good question. Great. Maybe a somewhat related question, not so much MVPs, but I think a bit more on the specifics. So, are there certain specialties or episodes of care which are at the top of your list for needing model development, for example, something you're hoping to work on sooner rather than later? Obviously, no specifics. There's no, you know, you can't give specifics, but just maybe a general sense of the kind of specialties or episodes that are really high on your list, and in particular, given the role of many of our societies in terms of providing some of the quality measures for those, that would then help, I think, some of our subsequent discussions as well. So, anything you want to add? Do you want to talk a little bit about that RFI? I can talk a little bit about it. I might jump to my colleague, Sarah Fogler, who's a little bit closer to it than I am, but Sarah, why don't I give this one to you, actually? Yeah, right, sure. So, there are conditions that we're interested in, and let me just give like one sentence or two, higher level than that, before I get into that deeper discussion, just to remind folks of what our task is at the Innovation Center, and it's really to design new service delivery and payment models that we can test for introduction into permanent traditional Medicare, and in some cases, Medicaid and the MA space. And so, one important piece for us to build a viable model test is that we have volume, and that we're able to construct, you know, these robust statistically significant tests that allow us to demonstrate impact on the back end, where we can actually say that our intervention has made a change and have the ability to scale. And so, to that end, most of the conditions that we're interested in, I think there's probably two primary parameters that we look at. The first is like where we have high volume, high cost conditions, and so we've been particularly interested in orthopedics, we've been interested in cardiology, and, you know, that's on the kind of chronic condition management side of the house. We're definitely also interested in things like oncology care. We're interested in kidney care. We're interested, as Rachel said, in dementia. So, there are other higher level conditions where we have these condition-oriented models, separate and apart from some of the work we're planning to target in our ambulatory specialty new design work that are really those high volume, high cost conditions. Susanna mentioned an RFI, and we are hoping to get more information about some new design concepts that are percolating. We've had a number of conversations to date through just individual conversations with societies. We've had some listening sessions. We've held roundtable discussions. We've been invited to other meetings to hear what folks are interested in seeing in the ambulatory specialty care space, and we're hoping within the next couple months, we will release an RFI for public comment to get some reactions on some of our early ideas and learnings, and that will inform our future work in this space that Rachel outlined in the next, like, two to three years. Great. Thank you so much, Sarah. Appreciate it. Another related question, is the intent to create new models that capture specialists or really integrate them more so into existing models? And the specific questioner asked, for example, you know, for the enhanced oncology model, will that eventually be expanded to account for things like the quality and cost of things like radiology or pain management? Any insights you could share there? So, at a very high level, what we test is what we have the ability to scale. And I think one of the exciting things that has taken shape since this administration has come in and reset our strategic agenda is thinking more expansively about defining success beyond just scaling a full model test, but actually scaling features of model tests. So, if we take EOM, for example, and even if I back up further to the test that we did on the oncology care model with oncology care, we like to help share the credit for traditional Medicare introducing patient navigation, for example, which was a feature of the oncology care model and is now a permanent feature of traditional Medicare. So, I think there is always an avenue and even a more recent avenue for us to introduce features of models into permanent change. So, I would say anything that we are actively testing, we're hoping to pursue either a full model scale test or features into expansion. Great. Anyone else want to weigh in? Okay. There was a question early on I want to go back to, which was specifically about how much you've been looking at the relationship between value-based purchasing and the documentation burden associated. Something, obviously, those of us in quality have heard about for a very long time. And are you even considering sort of the economic impact and any piloting to really assess that? That's a great question. And because the documentation burden comes in lots of places, I'm going to focus for a minute on sort of the concerns about the measurement pieces, but it's obviously not the only part. And I think one of the questions was, are we interested in that? And the answer is absolutely. And if people have, again, you want to highlight stuff that we may not be seeing that is impacting you, we want to know. So, for sure. But it is something that we think about pretty much every day. Our advancing quality strategy, our internal strategy has three main pillars and thinking about burden is one of them. The challenge is how do we advance measurements, move towards really important things, and how do we do that? And I think that's one of the advanced measurements, move towards really important outcomes, hearing directly from patients in our quality measurement, and recognize burden. And so, I think with every model, and Sarah and others, I'd be happy to have you weigh in as well, we are trying to balance those things. And one of the nice things about the Innovation Center work, I think, sometimes in comparison to other places, is that we do have the ability to provide some technical assistance. We sometimes are able to support the measurement burden. So, for example, I'll just give one example. We're introducing a new patient-reported outcome measure in the Making Care Primary. And for the practices that are most new who are coming in, we're going to really do a lot of the heavy lifting on the data collection, right? It's a small example, but it's sort of a place where we're trying to make sure that we're recognizing how much it takes for practices to build into a new model. I guess another example, actually, is the recently announced FEMA model, where we have a couple of years where we're focused mostly on supporting states before the full advanced payment model, and an alternate payment model kind of kicks in, so that we really are building in as much as we can, especially as we're bringing new provider groups in as much as we can. We're building in support to try to create some balance there. But let me pause and see, Sarah, if you have anything you want to add there. I have at least one – actually, I have two thoughts on that, different and separate and apart from Susanna's reactions on that question. But mine are, again, with this administration, I mean, we've done in pockets in the past some work around making infrastructure payments as part of our model test. And that has been a feature that we have introduced into our models more recently in several of our new models, hoping to better recognize the lift it takes to participate in the models, but more importantly, do this broader transformation work. And so, I just wanted to put a plug in for that acknowledgement and the funding we've put behind the acknowledgement to help reduce, hopefully, some of that burden and allow for hiring of new staff, et cetera. The other thing I would mention, and I'm really proud to toot the horn on this one, is that we are introducing new data efficiencies, system efficiencies, and I'll give you the example in the new guide model. We actually have a new API functionality, alternative programming interface – I can't believe I got that – but a new API functionality that is going to allow for much less burdensome assessment and enrollment into the model. So, it's not a lot of figuring out where in the EHR to put this information and having the EHR transfer that information to our systems and then the clunky feedback cycle for enrollment. So, maybe not exactly getting at the question, but just wanted you to know that we take burden extremely seriously from all points of infrastructure building to enrollment into our models to data reporting. And so, it's an active topic of conversation all day, every day over here. Wonderful. So, we've got, let's see, about six minutes left, and we've got two great questions. So, I'm going to ask these two to you. I guess the first is, do you have a vision or sort of a what you think would be the best case scenario for how you'd like to work with specialty societies? Lots of them have staff already working on models and measures, and what's your approach? I mean, should they schedule a time with you, or how would – should they do that through our convening, whatever you like? And the last one is specifically about measure development, so I want to save time for that. So, Sarah, I'm going to say a couple words and also have to, I think, you know, it's wonderful for us to have this convening, right, to have a center point for conversation. So, really appreciate that, but I think when we are, Sarah said this earlier actually, or Rachel did, when we are working on individual models that have a relationship to particular specialties, we are in lots of conversations already. I think that that has gone, from my perspective, quite well and will continue, but I think when we're thinking a little more broadly, as I'm hoping we will, around sort of the measure landscape or, you know, sort of directionality, there's a benefit to coming together and working with a central council, partly just for efficiency, quite honestly. But, Sarah, thoughts on sort of the individual model side of things? I'm not sure I have much to add. I mean, these RFIs are a beautiful way for us just to do a mass call for input. We like those a lot. We like the listening sessions, but other than that, Susanna, I think everything you said is, I'm in complete agreement with. Great. Thank you so much, both of you. The last one, I want to make sure we have time for, because I think it's a lot of what we have already been talking about in our collaborations to date. As you know, measure development and testing is expensive and puts a pretty significant burden on medical societies. Interest in potentially a sort of CMMI pathway for medical societies to work with you to test new measures to reduce burden, and I know that's something we've already talked about, and the questioner also specifically mentioned, for example, how expensive and time-consuming it is to work with RISDAC. Yeah, it's a great question, and it really was part of, I think, Helen, why you and I started talking, and I would love, actually, to turn it back to this group in some ways, to ask what people think is a feasible way to do things. Obviously, our authority is very based in the models we're building, so there's some limits to that, but we at the Innovation Center, part of our job is to build new things, and so doing that collaboratively is really good. The example I hearken to is now getting old, and it's not a perfect one, but I think it's useful when there was interest in a new patient-reported outcome for the hip and knee replacement. The CJR model was used as a way to collect data. There was an enormous amount of collaboration in the development of that measure on the basis of the data that was collected through that model, so there's certainly been an example, maybe not a perfect one, but that measure now has broader use, so it certainly stands as an example of ways that we've had, you know, new concepts where a society was involved, a model was used to bring data together, and a final measure was developed that has broader use. So, I think that's a starting place, but I do hope, Helen, that the conversations that you and I continue to have will kind of start to really look at this exact question. Right, absolutely, and certainly in some of the discussions we've already had with the Quality Peer Group as well as our Measurement Science Advisory Committee have really revolved around the question of how could we be helpful in terms of, for example, sharing a landscape of measures that might be in development but, you know, not yet ready for prime time that may need testing, and if there is sort of a potential model on the horizon, as you mentioned the example in orthopedics, where that could be beneficial to both by helping to move that forward. So, that's one of our next steps. We wanted to kind of have a chance to share with all of you where CMMI was, but I think our thought is to then go back, do more of a measurement landscape with the now 53 societies within CMSS and really begin to understand where are your measures in terms of development? Are there some that might logically line up with an upcoming model where you might be able to get the benefit of testing going forward? I know there's a strong interest in outcomes and, in particular, patient report outcomes, and that's what we're starting as part of the RFI. Yep, exactly, and I think, as Sarah said, you know, as we put things forward, you know, the more specific that you can respond and the RFIs or, you know, regulations that come out, that's really, really helpful to us. That's a great way for us to see, but as you and I said at the beginning, we're also going to continue these conversations and that measure landscape, understanding where the most promising work is already happening so we aren't missing it and where the most important gaps are is going to help us be smart about our measure selection and measure development activities. Thank you. This has been great, and obviously, it just shows the transparency and the willingness to work with us, which is really the intent of today kind of providing an update, but knowing that this is sort of the start of a conversation, not the end of a conversation, and really just want to thank Susanna and Jake and Rachel and and Sarah for joining us today, and Suzanne, Heidi, and Julia for helping us get this all set up, and we're really excited to work through next steps with all of you, and I think we're like one minute to go. If anybody, if Susanna or Jake or Rachel or Sarah have any final words, otherwise, I think we're good. All right. Thanks for the final word. Excellent, excellent. Thank you so much, team from CMI, and we'll be in touch with all the quality leads to go through next steps. Thanks again. Bye-bye.

CMI

specialty societies

accountable care

specialist integration

data transparency

financial incentives

documentation burden

quality measures