Gilfillan named acting director of Center for Medicare and Medicaid Innovation

The newly created Center for Medicare and Medicaid Innovation (CMI), which was created by the Patient Protection and Affordable Care Act (PPACA), has an acting director. Richard Gilfillan, MD, who has directed the Centers for Medicare and Medicaid Services' (CMS') performance-based policy staff since August, has been named acting director of CMI.  

According to the healthcare reform law, starting in 2011, CMI will develop and test pilot programs designed to decelerate the rising cost of Medicare and improve the program. CMI is, in essence, the research and development arm of CMS when it comes to testing payment and service delivery models.

Dr. Gilfillan will work with Donald Berwick, MD, who President Obama appointed as head of the Centers for Medicare and Medicaid Services in July.

Before Dr. Gilfillan began directing CMS’ performance-based payment policy staff, he was a consultant for Geisinger Consulting Services. Before that, he served as president and CEO of Geisinger Health Plan. While in that position, he spoke to Managed Healthcare Executive about the new payment structure the company had launched, which assigned a flat rate to certain procedures.

"Instead of having the perverse incentives that operate in fee-for-service care, we have an arrangement where [providers] are encouraged to do it right the first time," Dr. Gilfillan said during the interview. "We can stand behind the quality of care that we're offering, and then we can take that out to the marketplace, and over time, we would end up getting more patients and more market share. And at the same time, we would be pushing the system forward."

Dr. Gilfillan has more than 20 years of experience in healthcare. He began his career as a family practitioner, later becoming a medical director, a chief medical officer and a general manager in managed care. He earned undergraduate and medical degrees from Georgetown University and an MBA from the Wharton School of the University of Pennsylvania.

For the complete interview, see "Package pricing: Geisinger's new model holds the promise of aligning payment with optimal care."