Sunday, January 31, 2010

CMS Implements New Demos

A community-wide health information exchange in Indiana and a consortium of community care physician networks in North Carolina are two new CMS demonstrations to encourage the delivery of improved care to an estimated 130,000 beneficiaries in those states.

The Indiana Health Information Exchange will be the first demonstration to examine and implement a regional, multi-payer, pay-for-performance, and quality reporting program based on a common set of quality measures. It is unique among recent Medicare projects because now Medicare data will be used by the IHIE along with clinical and administrative data from other sources to provide participating physicians with improved information on their patients.

The North Carolina Community Care Networks (NC-CCN) demonstration will extend the medical home concept to low income Medicare beneficiaries, and to those eligible for both Medicaid and Medicare. NC-CCN will include eight regional health care networks in several North Carolina counties that will combine community-based care coordination plus health information technology to support more effective care management.

Caring for Medicare and Medicaid dually eligible beneficiaries can be fragmented even when the care for Medicaid is coordinated well. Often the states that utilize effective care management programs in their Medicaid programs do not extend their care programs to those eligible for both Medicaid and Medicare but with this demonstration, care will be extended to Medicare beneficiaries.

The networks will include community physicians’ hospitals, health departments, and other community organizations to serve as the medical home or primary source of care for dual eligible beneficiaries. Each network will employ clinical care coordinators who will work with practices to plan and coordinate care for all of the patients in the medical home. The networks will also measure care performance through quality measurements and implement performance incentives for effective care.

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