While I agree that improving the innovation process in health care is important - I think this is an utterly bizarre take. I will come back with a longer and more detailed response but for now a few points - the million hearts (more like 400,000 hearts) ended in disarray and disagreement as hospitals dropped out and CMS has dropped the program. It is a much better example of what not to do.
And in the case of the Diabetes Prevention Program - that was based first on a NIH funded study. Which, of course, went nowhere because organization of care/behavior change interventions have no route to become paid benefits like drugs and NIH doesn't want to get involved anyway. But the YMCA became interested and used it in the CMMI Innovation Challenge Grant program. However it is the only one of the ~200 grants in that program to result in the creation of a Medicare benefit. I would attribute this more to their lobbying power than CMS/CMMI process.
Especially because, when turning the results into a benefit, the CDC and CMS managed to create a one that is really hard to document and doesn't pay providers enough to do it. So despite years of tinkering, uptake/access of those who could benefit is minimal (fewer than 10,000 since inception in 2018).
This makes a lot of sense conceptually, but I wonder if Congress has the appetite to give the NIH waiver authority right now. ARPA-H was hard enough to stand up... asking lawmakers to let the NIH bypass its own statutory guardrails might be a bridge too far politically.
While I agree that improving the innovation process in health care is important - I think this is an utterly bizarre take. I will come back with a longer and more detailed response but for now a few points - the million hearts (more like 400,000 hearts) ended in disarray and disagreement as hospitals dropped out and CMS has dropped the program. It is a much better example of what not to do.
And in the case of the Diabetes Prevention Program - that was based first on a NIH funded study. Which, of course, went nowhere because organization of care/behavior change interventions have no route to become paid benefits like drugs and NIH doesn't want to get involved anyway. But the YMCA became interested and used it in the CMMI Innovation Challenge Grant program. However it is the only one of the ~200 grants in that program to result in the creation of a Medicare benefit. I would attribute this more to their lobbying power than CMS/CMMI process.
Especially because, when turning the results into a benefit, the CDC and CMS managed to create a one that is really hard to document and doesn't pay providers enough to do it. So despite years of tinkering, uptake/access of those who could benefit is minimal (fewer than 10,000 since inception in 2018).
And don't get me started on PCORI. . .
This makes a lot of sense conceptually, but I wonder if Congress has the appetite to give the NIH waiver authority right now. ARPA-H was hard enough to stand up... asking lawmakers to let the NIH bypass its own statutory guardrails might be a bridge too far politically.
From December 2025, an analysis showing that we spend more on writing and reviewing grant applications than we do on the actual research.
https://www.nature.com/articles/d41586-025-04060-x
And from further back, a simulation analysis positing that spreading the money around more would capture more new ideas.
http://www.pluchino.it/talent-vs-luck.html