Today’s post is on the Center for Medicare and Medicaid Innovation, which was created by Section 3021 of the Affordable Care Act and “supports the development and testing of innovative health care payment and service delivery models.” (quote is from the website). Under the direction of Richard Gilfillan, M.D. (director) and assisted by Sean Cavanaugh (Acting Deputy Director) and Thomas Reilly (Deputy Director), it pursues the following objectives:
- Testing new payment and service delivery models,
- Evaluating results and advancing best practices,
- Engaging stakeholders.
Testing innovative payment and service delivery models in an appropriate timeframe requires rapid-cycle evaluation, which is described in a recent article of my favorite magazine, Health Affairs. The article also “describes the relationship between the group’s work and that of the Office of the Actuary at the Centers for Medicare and Medicaid Services.”
Some of the models currently being evaluated and active programs include:
Accountable Care Organizations: referring to “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.” (The Center for Medicare and Medicaid Innovation is part of the Center for Medicare and Medicaid Services (CMS), the government agency behind Medicaid/Medicare [healthcare for the poor and the elderly].) The overall idea is that integrated care will lead to better care through improved coordination and thus lead to lower costs.
The video below from CMS explains ACOs (it was posted on YouTube by CMSHHSgov):
An example of ACO is the Pioneer ACO model. It is aimed at organizations that already have experience operating as ACO. Such new payment models are accompanied by requirements on reporting 33 quality measures, including the Consumer Assessment of Healthcare Providers and Systems (patient experience survey measures), claims-based measures, the Electronic Health Record Incentive Program measure , among many others, to make sure that the lower cost doesn’t come at the expense of quality. The Shared Savings Program is another related program attempting to rebalance financial incentives for providers.
Bundled Payments for Care Improvement Initiative: in this initiative, a single payment will be made for a full episode of care, instead of payments being made for every single resource used during treatment (tests, physicians’ time, etc), which “can result in fragmented care with minimal coordination”. The key, of course, is to define the bundle appropriately (and then set the correct price).
CMS is investigating four broadly defined models of care with participating organizations:
- Retrospective Acute Care Hospital Stay Only (the episode of care is defined as the inpatient stay in the acute care hospital),
- Retrospective Acute Care Hospital Stay plus Post-Acute Care (inpatient stay plus a defined number of days [30, 60 or 90] after hospital discharge),
- Retrospective Post-Acute Care Only (“the episode is triggered by an acute care hospital stay an will begin at initiation of post-acute care services”),
- Acute Care Hospital Stay Only (“CMS will make a single, prospectively determined bundled payment to the hospital”).
Payment arrangements will include financial and performance accountability. The website lists the 48 episodes covered by these payment models and related DRGs (Diagnosis-Related Groups).
Next week: health care innovation awards and state innovation models initiative.