[NYAPRS Enews] CMS Establishes Innovation Center, Awards NY Integrated Medicaid/Medicare Payment Demo

Wed Nov 17 10:10:08 EST 2010

Centers for Medicare & Medicaid Services (CMS)  

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 up to approximately 1,200 medical homes serving
up to 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 up to 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.  

More information on the CMMI and these initiatives is available at: 

www.innovations.cms.gov
<http://links.govdelivery.com:80/track?type=click&enid=bWFpbGluZ2lkPTEwO
DExMDEmbWVzc2FnZWlkPVBSRC1CVUwtMTA4MTEwMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsP
TEyNzY2NzE0NzcmZW1haWxpZD1oYXJ2ZXlyQG55YXBycy5vcmcmdXNlcmlkPWhhcnZleXJAb
nlhcHJzLm9yZyZmbD0mZXh0cmE9TXVsdGl2YXJpYXRlSWQ9JiYm&&&101&&&http://www.i
nnovation.cms.gov/> . 

----------

    CMS FACT SHEET

Nov. 16, 2010     

The Center for Medicare and Medicaid Innovation 

Created by the Affordable Care Act, the Center for Medicare and Medicaid
Innovation aims to explore innovations in health care delivery and
payment that will enhance the quality of care for Medicare and Medicaid
beneficiaries, improve the health of the population, and lower costs
through improvement. 

The Innovation Center will consult a diverse group of stakeholders
including hospitals, doctors, consumers, payers, states, employers,
advocates, relevant federal agencies and others to obtain direct input
and build partnerships for its upcoming work. This dialogue will center
on three areas of emphasis consistent with the Innovation Center's
goals. 

*        Better Care for Individuals: Improving care for patients in
formal care settings like hospitals, nursing homes, and doctors'
offices, and developing innovations that make care safer, more
patient-centered, more efficient, more effective, more timely, and more
equitable.  The Innovation Center will also promote the use of "bundled
payments," a more efficient approach to paying for care where providers
collaborate to manage multiple procedures as part of a single episode
with a single payment, rather than the current fee-for-service method of
submitting separate bills for each procedure, which leads to higher
costs. 

*        Coordinating Care to Improve Health Outcomes for Patients:
Developing new models that make it easier for doctors and clinicians in
different care settings to work together to care for a patient. Examples
include identifying and widely deploying the best advanced primary care
and health home models, and supporting innovations in accountable care
organizations.  

*        Community Care Models: Exploring steps to improve public health
and make communities healthier and stronger. The Innovation Center will
work to identify and address major public health crises and the
appropriate interventions for areas of great concern, such as obesity,
smoking, and heart disease. 

The Innovation Center will rigorously and rapidly assess the progress of
its programs and work with providers and other payers to replicate
successful innovations in communities across the country. It will test
models that include establishing "open innovation communities" that will
serve as information clearinghouses for best practices of health care
delivery reform. These communities will act as testing grounds for new
practices, yielding innovative ideas and lessons, and fostering ongoing
exchange on shared challenges.  

To initiate its work, the Innovation Center will have a series of open
forum calls and in-person regional community listening sessions that are
open to the public and will be hosted by Richard Gilfillan, M.D., Acting
Director of the Innovation Center. These meetings will help Innovation
Center leaders obtain input regarding the Center's goals, operating
plans and priorities.  Information about the Innovation Center and
upcoming calls and listening sessions will be www.innovations.cms.gov
<http://links.govdelivery.com:80/track?type=click&enid=bWFpbGluZ2lkPTEwO
DExMDEmbWVzc2FnZWlkPVBSRC1CVUwtMTA4MTEwMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsP
TEyNzY2NzE0NzcmZW1haWxpZD1oYXJ2ZXlyQG55YXBycy5vcmcmdXNlcmlkPWhhcnZleXJAb
nlhcHJzLm9yZyZmbD0mZXh0cmE9TXVsdGl2YXJpYXRlSWQ9JiYm&&&102&&&http://www.i
nnovations.cms.gov/> . 

Support for Care Coordination Programs as Part of the Innovation
Center's Launch 

In conjunction with the launch of the Innovation Center, CMS is also
announcing new initiatives to improve care for Americans enrolled in
Medicare and Medicaid.  These initiatives include: 

*        Expansion of the Multi-Payer Advanced Primary Care Practice
Demonstration: 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 payment from Medicare, Medicaid, and private
health plans. Maine, Vermont, Rhode Island, New York, Pennsylvania,
North Carolina, Michigan, and Minnesota will participate in this
demonstration that will ultimately include up to approximately 1,200
medical homes serving up to  one million Medicare beneficiaries.   

*        Announcement of the Federally Qualified Health Center (FQHC)
Advanced Primary Care Practice Demonstration:  This 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 up to 195,000
people with Medicare. 

*        Launch of the Medicaid Health Home State Plan Option:
Authorized by the Affordable Care Act, this new State plan option allows
patients enrolled in Medicaid with at least two chronic conditions to
designate a provider as a "health home" to 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
demonstration projects that will examine programs that fully integrate
care for individuals who are eligible for both Medicare and Medicaid
(i.e., dual eligibles). Dual eligibles account for 16 to 18 percent of
enrollees in Medicare and Medicaid, but roughly 25 to 45 percent of
spending in these programs respectively.  Significant health benefits
and savings can come from better coordinating the care of low-income
seniors and people with disabilities.  States may apply for resources to
support the demonstration projects they design beginning in December and
the Innovation Center will award up to 15 state program design contracts
up to $1 million each. 

The initiatives described above affect a broad range of providers, from
small rural physician practices to urban federally qualified health
centers.  They also involve multiple payers in both the public and
private sectors. Through these programs, CMS and the Innovation Center
will, by 2012, be a core partner in over 1,500 patient-centered primary
care practices that will provide integrated, coordinated care to
millions of Medicare and Medicaid beneficiaries, and we anticipate that
millions of others who will receive their care in these systems will
also benefit. 

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