Supporting Every Provider in Delivering Better, More Coordinated, Patient-Centered Care

By Dr. Rick Gilfillan, Director, Center for Medicare & Medicaid Innovation

This month, 88 new Accountable Care Organizations (ACOs) joined the other Medicare Shared Savings Program ACOs that came on line earlier this year.  Now, more than 150 organizations are partnering with Medicare in shared savings initiatives and offering more than 2 million patients better, more coordinated, patient-centered health care.

At the Centers for Medicare & Medicaid Services (CMS), we see ACOs as part of the future of health care—part of a broader movement from the old fee-for-service system that simply paid more for more services regardless of the outcome, to one that rewards providers for high-quality, coordinated care. 

Providers also see ACOs as a path to better health care.   During the rulemaking process for the Medicare Shared Savings Program, our agency heard from many small practices who wanted to become ACOs, but needed additional capital to meet the high bar for care coordination required of an ACO.  

We want to make sure that healthcare providers interested in forming ACOs have the opportunity to do so.  That’s why we created the Advance Payment Model—to provide entities such as rural and physician-owned organizations that hope to become ACOs in the Medicare Shared Savings Program with the support they need to invest in staff and in health information technology.  They will repay Medicare through savings they achieve.

Last week, CMS was proud to announce the second group of fifteen Advance Payment ACOs.  These organizations join five Advance Payment ACOs announced earlier this year.  Like their Medicare Shared Savings Program colleagues, they represent communities across America, and are made up of a diverse group of healthcare providers, including independent practice associations that are owned and operated by physicians. 

The interest of these small, independent practices in the ACO model demonstrates that the desire to improve care and lower costs through improvement exists in small practices as well as large health systems.  These providers are committed to improving the health and health care of their patients over the long haul. 

Recently, CMS announced that organizations accepted to the Medicare Shared Savings Program for January, 2013 would also have the opportunity to apply for Advance Payment Model.  At CMS, we’re committed to an ACO program that supports a diverse set of ACOs, allowing groups ranging from health systems to physician-led organizations to partner with us.

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.

We Can’t Wait: Jumpstarting Innovation in Health Care, Reducing Costs

By Donald M. Berwick M.D., Administrator, Centers for Medicare & Medicaid Services. Crosspost from Healthcare.gov

Health care costs remain a significant drain on the budgets of families, businesses, and federal and state governments. The health reform law, the Affordable Care Act, made significant strides in making Medicare more affordable and insurance companies more accountable. Congress is considering other ways to build on this progress, but we can’t wait to do more to help make our health care system more affordable.

In that spirit, the Obama Administration recently launched the Health Care Innovation Challenge. Made possible by the Affordable Care Act, this initiative will invest up to $1 billion in the best projects that doctors, hospitals, and other innovators propose to deliver high-quality medical care and save money. Projects that win this competition will use health care dollars more wisely, help create jobs, and help professionals improve the work they do for patients.

Innovation doesn’t happen in a vacuum and usually doesn’t start in Washington — we need the vision and experience of people who are already proving that our health care providers can and do provide better care and better health at lower cost. So we want to hear from you. Send us your innovative ideas and solutions, and submit a proposal outlining your vision for helping us transform the health care system. We’ll sort through these proposals and help put the best ones into practice.

If your proposal has strong evidence that it can start quickly, reduce costs, and improve health care, you can qualify for approximately $1 million to $30 million in an up-front investment. Priority is given to proposals that retrain workers and support job creation. You can find a fact sheet and the Funding Opportunity Announcement on our Healthcare Innovation Challenge Web page.

We’ll work with a wide variety of public and private organizations, including providers, payers, local governments, community and faith-based organizations, and other innovators whose compelling ideas can improve health care for patients. We are also looking for projects that help patients with the greatest health care needs, projects that can be up and running soon, and projects that rapidly hire, train and deploy health care workers.

For example, the Health Care Innovation Challenge could support the use of personal and home care aides to help the elderly stay in their homes or expanding the use of community-based paramedics to provide basic services to individuals in rural communities.

Different communities have different needs and circumstances—some require unique, locally driven innovations. With the Health Care Innovation Challenge, we hope to give providers even more opportunities to make our health care system even stronger.

We look forward to hearing your ideas on how to make this happen. For more information, you can also visit http://innovations.cms.gov/.

Innovations.cms.gov – a new website for a new approach to healthcare

This week, the Center for Medicare and Medicaid Innovation (“Innovation Center”) re-launched Innovations.cms.gov. Along with providing information about the Innovation Center’s mission and values, the website provides ways for the Innovation Center to gather new ideas to improve our health care system. The Innovations website also encourages patients, clinicians, and others to share those ideas and get involved.

About the Innovation Center:
Established under the Affordable Care Act, the Innovation Center’s mission is to help transform the American health care system by delivering better health and better healthcare for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, and to reduce costs through improvement. The Center will accomplish these goals by being a constructive and trustworthy partner in identifying, testing and spreading successful new models of care and payment.

Clinicians, health systems and community leaders throughout the country are developing new models that provide better health and better health care at lower costs. We want to partner with these innovators to help them succeed. Using an open, transparent, and competitive process, the Innovation Center will identify, select, support and evaluate models that show promise.

Share your ideas for testing the next generation of health care models.
We want your input for building the Center, and for identifying ways to deliver and pay for care that save money while improving health and health care for Medicare, Medicaid and CHIP beneficiaries.

What can we do to improve our nation’s health? How can we improve patients’ experience with the health care system? What will make health care more efficient and affordable? What is successful about the health care system in your community? We’ll take the best ideas, turn them into Innovation Center programs, and invite you and others to compete to bring them to fruition.

Join us in developing the Innovation Center and improving our healthcare system. Visit Innovations.cms.gov to learn more. We’re excited to have the opportunity to work with you.

Introducing the CMS Center for Medicare & Medicaid Innovation – and innovations.cms.gov

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services

Cross-posted from innovations.cms.gov.

We have been given a great opportunity – under the historic Affordable Care Act – to create the Center for Medicare and Medicaid Innovation.

The ultimate goal of the Innovation Center is to explore new approaches to the way we pay for and deliver care to patients so that we have better results both in terms of the quality of care and the affordability of coverage. Congress has charged this new CMS Center with identifying, testing and ultimately spreading new ways of delivering care and new ways of paying for care.

This is an enormous, challenging and exciting opportunity. But, we cannot do it alone. The Innovation Center will work with a diverse group of stakeholders including patient advocates, hospitals, doctors, consumers, employers, states, and other federal agencies to get the best ideas and put them to work.

We want to work with you to better understand your needs.

Introducing the Center for Medicare and Medicaid Innovation

The Innovation Center is different from what CMS has done before. The Innovation Center will rigorously and rapidly assess the progress of its programs and work with caregivers, insurers, and employers to replicate successful innovations in communities across the country.

The initial work of the Center will focus on three areas:

  • Better Care for People: Improving care for patients in hospitals, nursing homes, and doctors’ offices, and developing ways to make care safer, more patient-centered, more efficient, more effective, more timely, and more equitable.
  • Coordinating Care to Improve Health Outcomes for Patients: Developing new models that make it easier for doctors and nurses and other caregivers to work together to care for a patient.
  • Community Care Models: Exploring steps to improve public health and make communities healthier and stronger by fighting the epidemics of obesity, smoking, and heart disease.

Introducing innovations.cms.gov

Along with the Innovation Center, CMS is introducing a new Web site today – innovations.cms.gov. This website will:

  • Enable anyone who wants to help to join us on this endeavor.
  • Broadly share knowledge.
  • Work with integrated, interdisciplinary teams from all sectors and all backgrounds.

The Web site is the first step toward building a platform for collaboration and information sharing as we develop new care and payment models. Over the upcoming months, we will build out the capabilities of this site, so please check back frequently, subscribe to our blog, or subscribe to receive email updates.

None of this will be easy. Government cannot and should not do this alone. That’s why we are working with leaders in the private sector to come up with the best answers to the problems that face us all.

We hope that you will join us, too. What I ask for is your partnership and your input. I would like to help forge an unprecedented level of shared aim, shared vision, and synergy in action among the public and private stewards and leaders of health care.

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