New CBO Report Supports Innovation Center’s Approach to Improving Care

By Rick Gilfillan, Acting Dir. of the Center for Medicare & Medicaid Innovations. Crosspost from Healthcare.gov

The United States has one of the best health care systems in the world – and one of the most innovative.  We lead the world in developing new treatments, drugs and procedures to help heal patients.  At the same time, we know that we need to do more to help ensure every patient gets the very best care – and that we are spending our health care dollars wisely.

Last week, a report from the independent, non-partisan Congressional Budget Office (CBO) outlined how difficult this challenge is. The report showed how projects implemented by previous Administrations struggled to reduce Medicare costs.

And the same report recommended that future efforts focus on collecting better data, targeting resources at the patients who need it most, and encouraging care providers to work together.

Even before this report came out, the Center for Medicare and Medicaid Innovation was already putting some of these lessons and recommendations into practice.  The Innovation Center is charged with engaging doctors, hospitals, and other providers that want to try new approaches to keeping their patients healthy and out of the hospital. Here are just a few examples of how the Innovation Center has already adopted some of CBO’s recommendations:

  • CBO Recommendation: Gather timely data on the use of care, especially hospital admissions.
  • Innovation Center Action: Health systems participating in the Pioneer ACO and ACO Shared Savings models will receive updates on care received by their patients within a few weeks of when it occurred, down from 6 months or more in previous demonstrations.  
  • CBO Recommendation: Focus on transitions in care settings.  
  • Innovation Center Action: The Community-Based Care Transitions Program will invest up to $500 million in organizations such as Area Agencies on Aging that help seniors as they leave the hospital, including through home visits.  In addition, the Demonstration to Reduce Hospitalizations of Nursing Facility Residents will invest $134 million in providing additional care and supports to help reduce preventable hospitalizations among nursing home residents.
  • CBO Recommendation: Use team-based care.  
  • Innovation Center Action: The Comprehensive Primary Care Initiative provides new supports from both Medicare and private health insurers to make sure that participating primary care practices have robust care teams – which could include nurses, pharmacists, and dieticians – available 7 days a week to coordinate care and avert visits to the emergency room.
  • CBO Recommendation: Target interventions toward high-risk enrollees.
  • Innovation Center Action: Along with the Medicare-Medicaid Coordination Office, the Innovation Center is empowering states to invest in new models targeted toward beneficiaries that are eligible for both Medicare and Medicaid, a group of beneficiaries at particularly high risk for having multiple chronic health conditions and high health care costs.  
  • CBO Recommendation: Limit the costs of intervention.  
  • Innovation Center Action: The Innovation Center is testing several new payment models, such as the Pioneer ACO Model and the Bundled Payments for Care Improvement, with no upfront payments to participating doctors and hospitals.  Rather, these groups will be rewarded once their innovative approach is proven to have reduced costs and kept patients healthier.

In addition, the CBO report cited the Medicare Participating Heart Bypass Center Demonstration as one example of a pre-Affordable Care Act project that succeeded in reducing Medicare costs without harming the quality of care seniors received.  Based on this evidence, the Innovation Center launched in August of last year the Bundled Payment for Care Improvement initiative, which will allow seniors in other parts of the country to benefit from the success of the Heart Bypass Center Demonstration.

The Innovation Center is a new way of doing business for Medicare and Medicaid.  We are looking to models of health care that are already working in communities across America and finding ways to help doctors and hospitals in many other parts of the country make similar improvements for their patients. And we’re learning from Medicare’s previous work to develop better, more effective ways to save money and improve the quality of care. By putting into practice important lessons learned from both the private and public sectors, the Affordable Care Act is working to ensure that seniors in every community can enjoy the benefits of higher-quality, more affordable health care.

For more information on the Innovation Center you can visit www.innovations.cms.gov.

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