Accountable Health Communities Track 1 Funding Opportunity

By Patrick Conway, M.D., principal deputy administrator and chief medical officer, CMS

In January 2016, the Centers for Medicare & Medicaid Services (CMS) released a new Funding Opportunity Announcement (FOA) for a model called the Accountable Health Communities (AHC) Model. This is the first Center for Medicare & Medicaid Innovation model to focus on the health-related social needs of Medicare and Medicaid beneficiaries. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they are rarely, if ever, detected or addressed during typical health care-related visits. The AHC Model is based on emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs.

The original Funding Opportunity Announcement requested applications for three different scalable tracks featuring interventions of varying intensity that would address health-related social needs for beneficiaries. After receiving significant interest, inquiries and stakeholder feedback, CMS has decided to make modifications to the Track 1 application requirements and is releasing a new FOA specific to Track 1 of the AHC Model. CMS believes two key modifications to Track 1 will make the model more accessible to a broader set of applicants

  1. Reducing the annual number of beneficiaries applicants are required to screen from 75,000 to 53,000; and
  1. Increasing the maximum funding amount per award recipient from $1 million to $1.17 million over 5 years.

Track 1 will support bridge organizations that are working to increase a patient’s awareness of available community services through screening, information dissemination, and referral. The Track 1 approach seeks to address the decreased capacity of clinical delivery sites to respond to beneficiaries’ health-related social needs because (1) health-related social needs remain undetected due to the lack of universal screening and (2) clinical delivery sites and patients may lack awareness about existing community service providers that could address those needs.  Track 1 award recipients will partner with the state Medicaid agency, community service providers and clinical delivery sites to implement the Model.

The AHC Model complements CMS’ growing focus on population health by providing the necessary tools and support for a successful transition to a holistic health system. The AHC Model will also enhance CMS’ understanding of the impact of interventions to address social needs on health care costs.

We look forward to the applications to this FOA. Please contact us at the email address below for further information.

Application Information:

Under this announcement, CMS is accepting applications from community-based organizations, health care practices, hospitals and health systems, institutions of higher education, local government entities, tribal organizations, and for-profit and non-for- profit local and national entities with the capacity to develop and maintain relationships with clinical delivery sites and community service providers.  Applicants from all 50 states, U.S. Territories, or the District of Columbia (D.C.) may apply. All applicants, including those who applied to Tracks 1, 2 or 3 in the previous FOA, are eligible to apply to this FOA. Applicants that previously applied to Track 1 of the AHC Model under the original FOA (# CMS-1P1-17-001) must re-apply using this FOA (# CMS-1P1-17-002) to be considered for the Model.

The AHC Model is accepting applications for Track 1 at www.grants.gov through November 3, 2016.

Have a Question?

Questions about the AHC Model can be sent to AccountableHealthCommunities@cms.hhs.gov.

Additional Information:

For more information about the AHC Model, please visit our website at https://innovation.cms.gov/initiatives/ahcm. Follow us on Twitter at @CMSinnovates

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Looking Back on Promising Progress in Round One State Innovation Model, Looking Forward to the Future of State Based Innovation

by Patrick Conway, M.D., CMS Principal Deputy Administrator and Chief Medical Officer
The State Innovation Models (SIM) Initiative began in April 2013, and has supported over 38 states, territories and the District of Columbia in two rounds of awards.  Yesterday, we released the second annual independent evaluation report for the Round 1 State Innovation Model Test Awards, including the first findings available for SIM after the baseline data summary.  This report shows both progress in states being catalysts for health care transformation and the value of CMS’ collaboration with states. Today, we are releasing a Request for Information (RFI) to obtain input on the design and future direction of the SIM Initiative.

Overview of SIM

SIM states are testing strategies to transform health-care across their entire state, specifically to have a preponderance of payments to providers from all payers in the state be in value-based purchasing and/or alternative payment models.

In the SIM Initiative, CMS is testing models for how state governments can use their policy and regulatory levers to accelerate statewide health care system transformation from encounter-based service delivery to care coordination, and from volume-based to value-based payment.  Round 1 states are implementing statewide health care innovation plans that support health care transformation through a variety of methods, including:

  • primary care practice transformation through patient-centered, coordinated care;
  • integration of primary care with other health and social services, including behavioral health services and long-term services and supports;
  • payment reforms that promote delivery system transformation and a variety of enabling strategies to facilitate and sustain an improved health system that puts the patient at the center of care delivery; and
  • community-based population health and prevention.

Central to enhanced care coordination, population health, behavioral and physical health integration, and alternative payment models is the use of health information technology (IT) and a robust data infrastructure.  The Round 1 Test states are strengthening these capacities through:

  • engaging and supporting providers that have not typically been connected to health IT;
  • requiring participating providers to report on data and/or implement health IT;
  • making available patient-level health information to providers and systems to improve care coordination; and
  • improving data analytics to support quality improvement and payment reform, and aligning metrics and data infrastructure across payers and initiatives.

Evaluation findings from Year 2 of SIM Round 1

In SIM Round 1, Model Test awards were made to six states: Arkansas, Massachusetts, Maine, Minnesota, Oregon, and Vermont. The SIM Initiative has made notable progress in accelerating health care transformation among the Round 1 Test states. Over time, many states have been able to increase the populations served by their SIM-supported models.

  • Over 70% of eligible Medicaid primary care providers participate in Arkansas’ patient-centered medical home, which serves about 80% of their eligible Medicaid population.
  • Alternative payment models supported by SIM funds in Minnesota and Vermont are reaching about 50% of each state’s total population, with Oregon and Vermont also reaching over 80% of their total Medicaid population.

The evaluation found that states have been successful in engaging a wide swath of the payer, provider, purchaser, and patient communities and building stakeholder consensus by balancing standardization and flexibility when expanding payment reforms statewide. States have leveraged multi-payer efforts to implement payment and delivery system reforms, engaged the provider community in SIM-related activities, and used a range of policy levers to effect change. Some of the most substantial changes to delivery systems and payment methods are in areas where public and private payers are working together to accelerate transformation. For example:

  • In Arkansas, Arkansas Blue Cross Blue Shield, QualChoice and some large self-insured employer groups, including Walmart, participate in the SIM-supported patient-centered medical home and episode of care models.
  • Vermont’s SIM Initiative focuses on supporting Accountable Care Organizations. Providers participating in both Medicaid and commercial ACOs now represent a significant majority of the state’s available primary care providers. ACOs offer services to nearly all residents statewide, and about half of eligible beneficiaries were participating as of late 2014.
  • In Oregon, participation in the Coordinated Care Model under the SIM Initiative currently includes commercial insurance carriers contracting with the state to cover state employees and Medicaid beneficiaries.

It remains too early to attribute specific quantitative results directly to the SIM Initiative. However, analyses based on Medicare and commercial populations show that states were making progress on health outcomes, such as declines in emergency room visits and inpatient readmissions through models pre-dating SIM and models upon which SIM efforts are expanding. Future evaluation reports will provide more detail on quantitative results and whether and how the SIM Initiative is affecting and accelerating trends in health outcomes and spending.

SIM Supports Health Care Transformation

The Affordable Care Act provides tools through the CMS Innovation Center, like the SIM Initiative, to move our health care system toward one that provides better care to patients, spends dollars more wisely, and results in healthier communities. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate patient care to improve quality.

In 2015, the Administration announced goals for Medicare to tie payment to quality or value. These goals are for 30 percent of Medicare fee-for-service payments to be made through alternative payment models by the end of 2016 (and 50 percent by 2018), and tying 85 percent of payments to quality or value by 2016 (90 percent by 2018). In early 2016, the Secretary announced that HHS had reached its goal of 30 percent of Medicare payments made through alternative payment models ahead of schedule. HHS is also working with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models. Initiatives like SIM are an important part of states’ role in health care transformation and tying payments to quality or value.

Looking to the future, we are also seeking input through an RFI on the following concepts related to the evolution of the SIM Initiative:

  • Partnering with states to implement delivery and payment models across multiple payers in a state that could qualify as Advanced Alternative Payment Models (APMs) or Advanced Other Payer APMs under the proposed Quality Payment Program, making it easier for eligible clinicians in a state to become qualifying APM participants and earn the APM incentive;
  • Implementing financial accountability for health outcomes for an entire state’s population;
  • Assessing the impact of specific care interventions across multiple states, and;
  • Facilitating alignment of state and federal payment and service delivery reform efforts, and streamline interaction between the Federal government and states.

For more information on the RFI, please visit: https://innovation.cms.gov/Files/x/sim-rfi.pdf.  To be assured consideration, RFI comments must be received by October 28, 2016.  Comments should be submitted electronically to: SIM.RFI@cms.hhs.gov with “RFI” in the subject line.

CMS supports states through SIM and other innovation efforts to move towards this vision of multi-payer delivery system reform across an entire state.  Health system transformation and improvement happens at the state and local level and CMS will continue to support states in their transformation journey to improve care for people across the nation.

Helping Consumers Make Care Choices through Hospital Compare

By: Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality

When individuals and their families need to make important decisions about health care, they seek a reliable way to understand the best choice for themselves or their loved ones. That’s why over the past decade, the Centers for Medicare & Medicaid Services (CMS) has published information about the quality of care across the five different health care settings that most families encounter.[1] These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies. Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider.

Today’s ratings include the Overall Hospital Quality Star Rating that reflects comprehensive quality information about the care provided at our nation’s hospitals. The new Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections. Specialized and cutting edge care that certain hospitals provide such as specialized cancer care, are not reflected in these quality ratings.

We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information. In addition, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates.[2],[3]

Prior to publishing the Overall Hospital Quality Star Rating, we paused to give hospitals additional time to better understand our methodology and data. In response, we delayed the release of the ratings. Since then, we have conducted significant outreach and education to hospitals to understand their concerns and directly answered their questions, including:

  • Hosting two National Provider Calls with over 4,000 hospital representatives. During the calls, we walked through the Overall Hospital Quality Star Rating data and the methodology in detail while responding to questions that the attendees raised.
  • Providing specialized assistance to hospitals. We held numerous meetings with the hospital associations and individual hospitals to explain their data and answer questions.
  • Posting an evaluation of the national distributions of the Overall Hospital Quality Star Rating based on hospital characteristics. The analysis shows that all types of hospitals have both high performing and low performing hospitals.
  • Subjecting the measures used to calculate the Overall Hospital Quality Star Rating to rigorous scientific review and risk adjustment. All of the measures used to calculate the Overall Hospital Quality Star Rating are based on clinical guidelines and have undergone a rigorous scientific review and testing. The vast majority are endorsed by the National Quality Forum. Most of these quality measures are already adjusted for clinical co-morbidities to account for the illness-burden of the population. Some hospitals have raised the question of making additional adjustments to account for the sociodemographic characteristics of the patients they serve. We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE), who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures. We will work with ASPE and determine what next steps, if any, should be taken to adjust our measures based on the recommendations in the report.

CMS will continue to analyze the star rating data and consider public feedback to make enhancements to the scoring methodology as needed. The star rating will be updated quarterly, and will incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs.

Today, we are taking a step forward in our commitment to transparency by releasing the Overall Hospital Quality Star Rating. We have been posting star ratings for different facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries. We will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience.

These star rating programs are part of the Administration’s Open Data Initiative which aims to make government data freely available and useful while ensuring privacy, confidentiality, and security.

For more information please see https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-27.html.

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[1] CMS Compare websites include: Nursing Home Compare; Physician Compare; Medicare Plan Finder; Dialysis Compare; and Home Health Compare.

[2] Wang DE, Tsugawa Y, Figueroa JF, Jha AK. Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes. JAMA Intern Med. 2016;176(6):848-850. doi:10.1001/jamainternmed.2016.0784. http://archinte.jamanetwork.com/article.aspx?articleid=2513630

[3] Trzeciak, S. Gaughan, J. Mazzarelli, A. Association Between Medicare Summary Star Ratings and Clinical Outcomes in US Hospitals. Journal of Patient Experience. 2016 vol. 3 no. 1 2374373516636681 doi: 10.1177/2374373516636681 http://jpx.sagepub.com/content/3/1/2374373516636681.abstract

Advancing Health Equity for Sexual and Gender Minorities

By: Cara V. James, Ph.D., Director of the Office of Minority Health at the Centers for Medicare & Medicaid Services

Each June we celebrate National Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Month by increasing awareness of sexual and gender minority populations’ health disparities and advances in promoting health equity for all.

However, despite making progress on a state and national level with inclusive policies, this June we have been reminded that there are still many challenges to overcome. In many places young people are still distanced from their families because of their sexual orientation and gender identity. For many sexual and gender minorities in the U.S. it is still difficult to be out to family, friends, and co-workers. A survey of U.S. adults found that more than 75% of lesbian, gay, or bisexual respondents reported experiencing discrimination in their lifetime. Experiences of discrimination and unfair treatment have been linked to poor health outcomes among older adults who identify as lesbian, gay, bisexual, and transgender (LGBT). These stressors and impacts are amplified when individuals identify with multiple marginalized groups (e.g., sexual, gender, and/or racial minority). That said, studies have shown that LGBT individuals who have good social support have higher self-esteem, a more positive group identity, and more positive mental health.

Although we commonly speak about the LGBT community as a single population it is important to remember that it is actually made up of many diverse individuals from many unique backgrounds and just about as many different ways of identifying themselves. At CMS it is especially important to remember that racial and ethnic minorities, people with disabilities, and older adults may also be sexual and gender minorities.

The CMS Office of Minority Health strives to increase understanding and awareness of disparities, create and share solutions to address those disparities, and implement effective actions to achieve health equity. To that end, we are developing a web-based training to aid providers in the collection of sexual orientation and gender identity (SOGI) data. We are working on a new best practices tool box for providing culturally and linguistically appropriate services (CLAS) with an emphasis on sexual and gender minorities and people with disabilities.

What can you do? Get informed. Learn more about health disparities for sexual minorities age 65 and older in CMS’ June data brief. Find out about the Office for Civil Rights’ rule highlighting your right to be free from discrimination in health careimplementing regulations under on the basis of sex, including sex stereotyping and gender identity. You can also learn more about LGBT health and well-being by looking at the work of our sister agencies within HHS. Think about how you can contribute to bringing health equity to your work. We encourage you to join us on the path to health equity by using the resources discussed in this blog, bookmarking the CMS OMH website, joining our listserv, and of course building on your own health equity activities!

CMS Provides Additional Resources to Improve Care and Prepare for the Quality Payment Program for Clinicians

By: Patrick Conway, MD, MSc, CMS Acting Principal Deputy Administrator and Chief Medical Officer

Last year, an overwhelmingly bipartisan Congressional majority – with the support of the medical community and stakeholders – passed the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. The law ended more than a decade of last-minute fixes and 17 potential payment “cliffs” for thousands of Medicare fee-for-service clinicians, while moving away from paying for each service a physician provides towards a system that rewards physicians for coordinating their patient’s care and improving the quality of care delivered.

Over the past year, we have worked in the same spirit as the law’s model of partnership and progress as we implement policies to improve the health and well-being of Americans. Today, the Centers for Medicare & Medicaid Services (CMS) announces up to $10 million over the next three years to fund the second round of the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI).

TCPI currently consists of 39 national and regional health care networks and supporting organizations – Practice Transformation Networks and Support and Alignment Networks – that provide assistance to thousands of clinicians in all 50 states to improve care coordination and quality and to better understand their patients’ needs. These networks are a key support for clinicians preparing for the payment changes under MACRA by helping clinicians transform the way they deliver care and participate in Alternative Payment Models (APMs), a key part of the proposed Quality Payment Program.

Eligible Medicare clinicians in the proposed Quality Payment Program who sufficiently participate in Advanced APMs could receive a 5 percent bonus Medicare payment beginning in 2019 for their participation in the 2017 performance period. Eligible clinicians who participate in the proposed Quality Payment Program through the Merit-based Incentive Payment System (MIPS) could also benefit from participating in APMs. By participating in these models, the eligible clinicians could receive a favorable scoring standard under MIPS, as well as extra credit in the Clinical Practice Improvement Activities performance category. Clinicians who perform well under MIPS in the 2017 performance period may qualify for up to a 4 percent Medicare payment adjustment in 2019, with additional bonuses for the highest performers.

TCPI helps more clinicians to improve quality, coordinate care, and spend dollars more wisely by providing peer-to-peer support to primary and specialty physicians, nurse practitioners, physician assistants, clinical pharmacists, and their practices. For clinicians that elect to participate in MIPS, this support will help them be successful. Participating networks also disseminate best practices and provide technical assistance and coaching to practices that are moving towards participation in APMs.

Today’s announcement continues to support clinicians across the country in transforming their practices by requiring competitive applications to have signed commitments to enroll a minimum 5,000 or more eligible clinicians and their practices in their network. These clinician practices must be advanced in delivering high-quality and efficient care, so that they can quickly learn from the initiative, support improvement at scale, and join APMs.

As a practicing physician, I know the importance of quality improvement support and sharing of best practices to help clinicians transform their practice and deliver outstanding care to every patient.

CMS encourages all qualified entities to apply for the Support and Alignment Network 2.0 funding opportunity so that we can continue to build on the successes we have made so far.

If you are a clinician who is interested in finding a Support and Alignment Network or Practice Transformation Network near your practice, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-09-29.html.

For more information on the Transforming Clinical Practice Initiative, please visit: https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/.

For a fact sheet on the Support and Alignment Network 2.0 Funding Opportunity Announcement, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-10.html.

CMS Continues Progress toward a Safer Health Care System through Integrated Efforts to Improve Patient Safety and Reduce Hospital Readmissions

By: Patrick Conway, MD, MSc, CMS Acting Principal Deputy Administrator and Chief Medical Officer

We know that it is possible to improve national patient safety performance resulting in millions of people avoiding infections and adverse health events. A report released by the Agency for Healthcare Research and Quality back in December showed an unprecedented 39 percent reduction in preventable patient harm in U.S. hospitals compared to the 2010 baseline. This has resulted in 2.1 million fewer patients harmed, 87,000 lives saved, and nearly $20 billion in cost-savings from 2010 to 2014. The nation has also made substantial progress in reducing 30-day hospital readmissions.

I have been working in the field of quality improvement for 20 years, and I have never before seen results such as these. This work, though, is far from done, and it is imperative that we sustain and strengthen efforts to address patient safety problems, such as central line infections and hospital readmissions. Today, we at CMS are excited to continue progress toward a safer health care system by releasing a Request for Proposal (RFP) for Hospital Improvement and Innovation Networks (HIINs).

The HIINs, which will be part of the Quality Improvement Organization (QIO) initiative, will continue the good work started by the Hospital Engagement Networks (HENs) under the Partnership for Patients initiative. These organizations will tap into the deep experience, capabilities and impact of QIOs, hospital associations, hospital systems, and national hospital affinity organizations with extensive experience in hospital quality improvement. The HIINs will engage and support the nation’s hospitals, patients, and their caregivers in work to implement and spread well-tested, evidence-based best practices.

QIOs that have developed strong relationship with HENs under the Partnership for Patients initiative have decades of experience with quality improvement and are currently supporting more than 250 communities nationally in work to improve care transitions and reduce adverse drug events across a wide variety of health care and community-based organizations.  HENs involved in supporting the Partnership for Patients initiative have established relationships and trusted partnerships with over 3,700 acute care hospitals. These efforts involve approximately 80 percent of all people discharged from hospitals across the nation.

The further integration of work across these influential networks will permit the continued and increased systematic use of proven practices to improve patient safety and reduce readmissions, at a national scale in all U.S. hospitals. Through 2019, the new HIINs will commit to and pursue bold new national aims to achieve a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions as a population-based measure (readmissions per 1,000 people) from the 2014 baseline, thereby bolstering the impact of both the QIO program and the Partnership for Patients.

The procurement for the HIINs will be a full and open competition, and CMS encourages all interested parties to submit a proposal that will continue to build on the successes achieved so far. Organizations who were a HEN in the first and second rounds of the Partnership for Patients or QIOs and other organizations that meet the RFP criteria are welcome to submit a proposal for the HIIN opportunity, but will compete for selection against all other organizations submitting proposals.

More information about today’s RFP may be found at FedBizOpps.gov.

Round One Health Care Innovation Awards Show Some Promising Results

By: Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer

The Health Care Innovation Awards is a Centers for Medicare & Medicaid Services (CMS) Innovation Center initiative that tests new payment and service delivery models and aims to find better ways to deliver care and bring down costs for Medicare, Medicaid, and/or Children’s Health Insurance Program (CHIP) enrollees. Today we are sharing the second annual independent evaluation reports of round one of the Health Care Innovation Awards. Overall, these evaluation reports show a wide range of experiences that have resulted in tangible benefits for patients and helped inform CMS in the development of new payment and service delivery models.

Where data are available, these reports describe preliminary impact estimates on key outcome measures such as hospitalizations and readmissions. A number of awardees showed favorable results on one or more measures of cost, hospitalizations, readmissions, and emergency room visits. Here are some early highlights of a few of the awards:

  • Innovative Oncology Business Solutions, Inc. – through its Community Oncology Medical Home – reached more than 2,100 cancer patients through seven community oncology practices across the United States. Through comprehensive and coordinated oncology care, the model established pathways that:
    • allowed providers to identify and manage symptoms in real time;
    • improved patient access to providers through same-day appointments and extended night and weekend office hours; and
    • provided disease management guidance for providers to improve treatment decision-making, symptom recognition, and assistance with patients’ self care, pain management, and caregiver support.

The evaluation report shows that this award demonstrated a significant reduction in hospital readmissions and emergency room visits. In addition, qualitative findings suggest that staff highly value the triage pathways for making their workflow more efficient, and patients greatly appreciate weekend hours and increased capacity for urgent care visits during the day. Elements of this model were incorporated into the design of the Oncology Care Model.

  • The High-Risk Children’s Clinic at the University of Texas Health Science Center at Houston’s (HRCC) offered dedicated outpatient services (primary, specialty, post-acute, chronic disease management) and around-the-clock phone access for extremely fragile and complex chronically ill children enrolled in Medicaid. Every family in the HRCC has an assigned clinician who involves the parent in all health assessments, empowering parents as experts in their child’s health condition and educating families on exacerbating symptoms. The evaluation found that the program significantly reduced emergency department visits and hospital admissions, which drove savings in medical and hospital cost of care for participating children. In addition, the report finds that the patient and family centered approach appears to have resulted in improved patient and family caregiver experience.
  • Welvie is a program that offers education, health information, and decision-making resources regarding preference-sensitive surgeries to Medicare beneficiaries. Welvie conducts regularly scheduled, population-based outreach well before treatment decisions need to be made. Program administrators also review regional health care utilization patterns and mail outreach materials to arrive before periods of increased surgery utilization so that beneficiaries can recall and access the resources when needed. The program has enrolled over 181,000 beneficiaries in Ohio and almost 54,000 beneficiaries in Texas. Enrollees in Ohio had a statistically significant decrease in mortality as well as indications of a reduction in hospital readmissions following surgery-related hospital admissions for the Medicare FFS beneficiaries. The program was also associated with reductions in various surgery-related categories of expenditures among Medicare Advantage beneficiaries.

Diabetes Prevention Program

We recently announced that a round one Health Care Innovation Awards project — the Diabetes Prevention Program – is eligible for expansion under Medicare. The National Council of Young Men’s Christian Associations of the United States of America (Y-USA) enrolled eligible Medicare beneficiaries at high risk for diabetes in a program that could decrease their risk for developing serious diabetes-related illnesses. Beneficiaries in the program attended weekly meetings with a lifestyle coach who trained participants in strategies for long-term dietary change, increased physical activity, and behavior changes to control their weight and decrease their risk of type 2 diabetes. After the initial weekly training sessions, participants could attend monthly follow-up meetings to help maintain healthy behaviors. The main goal of the program was to improve participants’ health through improved nutrition and physical activity, targeting at least a five percent weight loss for each individual.

The independent CMS Office of the Actuary certified that expansion of the Diabetes Prevention Program would reduce net Medicare spending. The expansion was also determined to improve the quality of patient care without limiting coverage or benefits. This is the first time that a preventive service model from the CMS Innovation Center has become eligible for expansion into the Medicare program.

Health Care Innovation Awards Background

In July 2012, the CMS Innovation Center awarded 107 cooperative agreements through round one of the Health Care Innovation Awards to implement the most compelling ideas that aimed to deliver better care while spending health care dollars more wisely. Up to $1 billion were awarded to organizations that tested projects across the country that worked to achieve better quality of care and save money for people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program. The evaluation reports are divided into large topical areas:

  • Behavioral health and substance abuse;
  • Complex and high risk patient targeting;
  • Community resource planning and prevention;
  • Disease specific;
  • Hospital interventions;
  • Primary care redesign; and
  • Shared decision making/medication management

The first annual evaluation reports were released in April 2015 and provided qualitative findings largely focusing on the implementation experience covering the period from the award date through summer 2014. The reports released today synthesize findings from additional rounds of interviews and site visits conducted from the award date through summer 2015, preliminary estimates of impacts on four core measures (cost, hospitalizations, readmissions, emergency room visits) depending on the intervention and data availability, and results from select surveys of providers focusing on workforce and primary care.

While the results of the awards are wide-ranging, the evaluation of round one of the Health Care Innovation Awards is still ongoing and future reports will add to the current results. There is still much to learn, and we hope that other public and private entities will continue to invest in initiatives and efforts that improve the health care system in this country.

For more information on round one of the Health Care Innovation Awards and to view the second annual evaluation reports, please visit: https://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/

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