I’m not sure whether Trump’s executive orders to lower drug prices will work, but I salute the effort. Meanwhile, out of the spotlight, the federal health agencies are making real progress to cut costs and improve the healthcare system. A thread of specific actions underway: 1/10

The industry has pressured the FDA to approve any drug targeting a rare disease, even without any evidence a drug is safe or effictive. The FDA is now enforcing the statutory requirement of “substantial evidence of effectiveness” in drug approval. 6/10

CMMI was created to test payment models other than fee-for-service, which has terrible incentives. Historically, it allowed providers to opt-in to pilot reimbursement programs, making it hard to know whether they worked. CMMI wants to randomize new models to ensure learning. 7/10

The billing rates for 10,000+ procedures are very old, are heavily influenced by the physician lobbying group, don't discourage low-value care and create pay imbalances among docs. CMS has proposed adjusting the formula to provide more equitable and efficient reimbursements. 8/10

Last thought ... All of these agency efforts would be much easier to execute with Congressional action, but the latter is mostly checked out on these issues, too captured by industry lobbyists and with little to no interest in cutting spending.