News Briefs: Trump’s CMMI Pick Says Claims History Should Be Enough for Risk Adjustment

Jan 16
Jan 16, 2025

After STAT News reported that Abe Sutton is President-elect Donald Trump’s first choice to oversee the CMS Center for Medicare and Medicaid Innovation (CMMI), the Washington Post named two more potential CMS deputies: Chris Klomp and Stephanie Carlton. During a podcast hosted by Gabe Drapos, chief operating officer of Pearl Health, Sutton in November 2024 discussed Medicare Advantage risk adjustment, describing a system creating “haves and have-nots” where “very large health plans have the resources to go out into the field” and document codes to gather more diagnoses, audit charts, coach physician practices and resubmit claims, compared to a “smaller health plan that doesn’t have any of those resources.” He suggested that without all that additional work, a patient’s full claims history captured by health plans and the federal government “should be sufficient at a population level to infer the risk of a patient without any need for documentation.” Sutton also discussed “proposing a test model” to avoid “services that are unnecessary to receive additional reimbursement.” Klomp is a tech entrepreneur, having worked at health care IT firm Collective Medical (before it was acquired by PointClickCare) and serving as a board member of Maven Clinic, a virtual provider of women’s and family care, and he is reportedly being considered to lead the Center for Medicare. Carlton is a partner at McKinsey & Co. and a former GOP Senate staffer, according to the Jan. 14 Washington Post article, and she would serve as chief of staff under Mehmet Oz, M.D., Trump’s pick for CMS administrator. Sutton, a former HHS policy adviser under Trump, is a principal with Rubicon Founders, which was founded by Adam Boehler, who was director of CMMI during the first Trump administration.
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.