The CMS took its official first steps toward the agency’s goal of a coordinated healthcare system last week when it launched the Center for Medicare and Medicaid Innovation.
CMS' innovation lab
Projects are aimed at coordinating care system
Established in this year’s Patient Protection and Affordable Care Act (June 14, p. 6), the much-anticipated “Innovation Center,” as it’s being called, is meant to study new ways of delivering healthcare and paying providers that save money and improve quality simultaneously.
The new center is “a crosscutting resource to test change and accelerate progress in pursuing the goals of better care, better health and lower cost through improvement of care, focusing on individuals, integration of care and prevention,” CMS Administrator Donald Berwick wrote in Senate Finance Committee testimony for the record last week (See story, below). During his Senate committee appearance, Berwick said the Innovation Center is important because it will encourage local settings to devise the kind of coordinated care that works for them.
In an interview, Richard Gilfillan, the acting director of the center, talked about the organization as an explicit part of the Affordable Care Act, and said he thought Congress believed it was important to create an organization that was consistent with its vision of improving payment methodologies over time. “In the past, the cycle time had been slow—they felt that it was important to create a context and entity that would be more flexible and more nimble and help CMS and the federal government learn quicker,” Gilfillan said.
On a call with reporters, Gilfillan said work has already begun. “We’re not just in a planning process. As part of the launch, we’re announcing four projects that have great promise for patients.”
The first of these programs is a demonstration project to evaluate the effectiveness of physicians and other healthcare professionals working in a more integrated way and receiving payment from Medicare, Medicaid and private health plans. Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont were the eight states chosen to participate in the demonstration, which will include up to 1,200 medical homes serving up to 1 million Medicare beneficiaries.
The CMS also announced a demonstration to measure the effectiveness of professionals working in teams to treat low-income patients at federally qualified community health centers; the Innovation Center will conduct the demonstration in up to 500 of these facilities and provide coordinated care for up to 195,000 people with Medicare.
Medicaid as well as dual beneficiaries are the focus of the remaining two projects. The first, authorized by the Affordable Care Act, is a state plan option that would allow patients enrolled in Medicaid with at least two chronic conditions to designate a provider as a health home to help coordinate treatments. “States that implement this option will receive enhanced financial resources from the federal government to support health homes in their Medicaid programs,” the agency said in a news release.
The other is a future program for which states can begin applying in December. That project will examine programs that integrate care for those individuals who qualify for both Medicare and Medicaid, also known as “dual eligibles.” According to the CMS, this patient population accounts for between 16% and 18% of the enrollees in Medicare and Medicaid, but for between 25% and 45% of spending in these programs. The CMS will award $1 million apiece for up to 15 state program design contracts.
“Historically, CMS had independent demonstration projects, but as the center was announced yesterday by Berwick and Gilfillan, it was to say: ‘How could we take the best examples and how do we rapidly learn from them and rapidly diffuse information?’ ” said Sam Nussbaum, executive vice president and chief medical officer at insurer WellPoint in Indianapolis.
Nussbaum said the center’s creation is an important statement by HHS and the CMS to the private sector about improving the underlying coordination of care and how that care is delivered. Nussbaum—who participated in last week’s launch—said the state of Colorado has made great strides with coordinated care.
In Vermont, a model of collaboration has existed in the Vermont Blueprint for Health since its inception in 2003. Lisa Dulsky Watkins, a pediatrician who is the project’s senior associate director, said the group works with commercial insurers, consumer organizations, the hospital association and others to redesign the state’s health system. The foundation for this is a patient-centered medical home that promotes a team approach to care in which a “community care team” of nurse coordinators, social workers, nutritionists and other health professionals help patients manage chronic conditions.
The key to an effective demonstration, Dulsky Watkins said, is making sure that care-coordination programs are designed at the local level by people who best know the community and patient population.
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