CMS Introduces New Center for Medicare and Medicaid Innovation, Initiatives to Better Coordinate Health Care

New Demonstration Program Support Innovation Center Goals

Nov. 16, 2010

The Centers for Medicare & Medicaid Services (CMS) today formally established the new Center for Medicare and Medicaid Innovation (Innovation Center). Created by the Affordable Care Act, the Innovation Center will examine new ways of delivering health care and paying health care providers that can save money for Medicare and Medicaid while improving the quality of care. CMS also announced the launch of new demonstration projects that will support efforts to better coordinate care and improve health outcomes for patients.

 

"For too long, health care in the United States has been fragmented-failing to meet patients' basic needs, and leaving both patients and providers frustrated. Payment systems often fail to reward providers for coordinating care and keeping their patients healthy reinforcing this fragmentation," said Donald Berwick, M.D., CMS Administrator. "The Innovation Center will help change this trend by identifying, supporting, and evaluating models of care that both improve the quality of care patients receive and lower costs."

 

"The Innovation Center will be a new, and much needed driver of innovation aimed at improving health care for Medicare and Medicaid beneficiaries. The Center will identify and test care models that provide beneficiaries with a seamless care experience, better health and lower costs," said Acting Innovation Center Director, Richard Gilfillan, M.D. "By working together with innovative and committed providers we can create a system that works better for everyone. We want to identify, validate, and scale models that have been effective in achieving better outcomes and improving the quality of care, but may be relatively unknown."

 

The Innovation Center will consult stakeholders across the health care sector including hospitals, doctors, consumers, payers, states, employers, advocates, relevant federal agencies and others to obtain direct input on its operations and to build partnerships with those that interested in its work. The organization will also test models that include establishing an "open innovation community" that serves as an information clearinghouse of best practices in health care innovation. The Center will also work with stakeholders to create learning communities that help other providers rapidly implement these new care models. As part of this engagement, today, Administrator Berwick and Acting Director Gilfillan, met with stakeholders representing the health care industry, as well as consumers, states, and employers, to discuss the Innovation Center and its planned activities.

 

CMS also announced several new initiatives to strengthen primary care and better coordinate care for patients.

 

"Health care is often fragmented, causing confusion, waste, and sometimes poor outcomes," said Dr. Berwick. "Primary care that is person-centered, coordinated, and seamless - creating a 'health home' - is a foundation upon which a high performing system that delivers health, not just care, needs to be built."

 

New initiatives will test "health home" and "medical home" concepts:

 

  • Eight states have been selected to participate in a demonstration project to evaluate the effectiveness of doctors and other health professionals across the care system working in a more integrated fashion and receiving more coordinated payment from Medicare, Medicaid, and private health plans. Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota will participate in the Multi-Payer Advanced Primary Care Practice Demonstration that will ultimately include over 1,200 medical homes serving almost one million Medicare beneficiaries.
  • The Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration will test the effectiveness of doctors and other health professionals working in teams to treat low-income patients at community health centers. The demonstration will be conducted by the Innovation Center in up to 500 FQHCs and provide patient-centered, coordinated care to approximately 195,000 people with Medicare.
  • A new State plan option under which patients enrolled in Medicaid with at least two chronic conditions can designate a provider as a "health home" that would help coordinate treatments for the patient. States that implement this option will receive enhanced financial resources from the Federal government to support "health homes" in their Medicaid programs.

The Innovation Center also announced an upcoming opportunity for States to apply for contracts to support development of new models aimed at improving care quality, care coordination, cost-effectiveness, and overall experience of beneficiaries who are eligible for both Medicare and Medicaid, also known as "dual eligibles." The Innovation Center expects to award up to $1 million in design contracts to as many as 15 state programs for this work. In addition, the Innovation Center will support two additional dual eligible health care integration demonstrations that will be announced in 2011 and will focus on the role of providers and beneficiaries, respectively.

 

More information on the CMMI and these initiatives is available at: innovation.cms.gov

 

 

The Centers for Medicare & Medicaid Services (CMS) announced the establishment of a center that will test new, innovative models of payment and health care delivery designed to reduce Medicare and Medicaid expenditures while preserving or enhancing the quality of care.

 

The Center for Medicare and Medicaid Innovation (CMMI) was authorized under Section 3021 of the Affordable Care Act. CMS Administrator Donald Berwick, M.D., and Acting CMMI Director, Richard Gilfillan, M.D., met with stakeholders representing the health care industry, as well as consumers, states, and employers, to introduce the new Center.

 

"The Center for Medicare and Medicaid Innovation will be a new, and much needed driver of innovation aimed at improving health care for Medicare and Medicaid beneficiaries," said Berwick. "The Center will identify and test models of care that provide beneficiaries with a seamless care experience, better health and lower costs through improved care processes and will share information on these new models of care with the public. We believe that by working together with innovative and committed providers we can together create a system that works better for all Americans."

 

Identify, Evaluate, and Disseminate Information on New Models of Care

 

Congress has provided the CMMI with substantial funding to identify, evaluate, and disseminate information on new models of care, including $10 billion for fiscal years 2011-2019. The law also gives the Secretary of Health and Human Services new authority to expand the duration and scope of models that improve quality and reduce cost. This will allow CMS to speed the introduction of successful innovations through its Medicare, Medicaid, and CHIP programs without having to seek specific legislative authority.

"The work of the CMMI will be designed to ensure rapid deployment of models that work and to allow for continuous feedback to support rapid learning, adjustment, and evaluation," said Gilfillan. "We want to identify, validate and scale models that have been effective in achieving better outcomes, but may be relatively unknown."

 

CMMI will consult with a diverse group of stakeholders including relevant federal agencies, hospitals, doctors, consumers, payers, states, employers, advocates, and others to obtain direct input on its mission and planned work. CMMI will also test models that include establishing an open innovation community with a combination of online and in-person interaction.

 

In conjunction with the CMMI launch, CMS also announced several new initiatives to support strengthened primary care and seamless, coordinated experiences across health care settings.

"Health care is often fragmented, causing confusion, waste and sometimes poor outcomes," said Berwick. "Primary care that is person-centered, coordinated and seamless - creating what many call a "medical home" or "health home" - is a foundation upon which a high performing system that delivers health, not just care, needs to be built."

 

Three initiatives will test the "medical home" concept:

 

CMS announced the eight States selected to participate in the Multi-Payer Advanced Primary Care Practice Demonstration. Medicare will join ongoing multi-payer, state-based demonstrations in Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. Together, these eight states are expected to ultimately include over 1,200 medical homes serving almost one million Medicare beneficiaries.

 

The Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration will evaluate the impact of this care model on access, quality and cost of care provided to low-income beneficiaries served by these facilities. The demonstration, originally announced December 2009, will be conducted by the CMMI in up to 500 FQHCs and provide patient-centered, coordinated care to approximately 195,000 people with Medicare.

 

CMS issued a letter to State Medicaid Directors, with guidance on the implementation of Section 2703 of the Patient Protection and Affordable Care Act, which establishes a new State plan option under which Medicaid enrollees with at least two chronic conditions, one chronic condition and the risk of developing a second, or one serious and persistent mental health condition could designate a provider as a "health home". The new State plan option provides States that take up this option with an enhanced Federal match of 90 percent for the health home benefit for the first eight quarters the option is in effect. Other health care services for program participants will continue to be matched at the State's regular matching rate.

 

Opportunity for States to Apply for Program Design Contracts

 

The CMMI also announced an upcoming opportunity for States to apply for program design contracts to support the development of demonstration models aimed at improving the quality, care coordination, cost-effectiveness, and overall experience of care for dual eligible beneficiaries. In addition, CMMI will support two additional dual eligible care integration demonstrations that will be announced in 2011 and will focus on providers and beneficiaries, respectively.

 

"We are very pleased to have the opportunity to announce this initial set of activities for the Center," said Berwick. "We also look forward to engaging interested stakeholders in a series of conversations regarding the CMMI mission, operating model and priorities."

 

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