Sunday, November 21, 2010

CMS Establishes Initiatives

CMS has formally established the new Center for Medicare and Medicaid Innovation created by the Affordable Care Act. The Innovation Center will examine new ideas and ways to more effectively deliver healthcare in the future.

The Innovation Center will:

• Consult with stakeholders across the healthcare sector including hospitals, doctors, consumers, payers, states, employers, advocates, relevant federal agencies, and others to obtain input and to build partnerships

• Test models to establish an open innovation community to serve as an information clearinghouse on best practices in healthcare innovation

• Create learning communities to help other providers rapidly implement new care models

The Innovation Center announced an upcoming opportunity available to States to apply for contracts to develop new models to improve healthcare, quality, care coordination, cost effectiveness, and to help benefit beneficiaries. The Innovation Center expects to award up to $1 million in design contracts to as many as 15 state programs for this work.

CMS has announced several new initiatives to test the “health home” and “medical home” concept. One initiative involves the “Multi-Payer Advanced Primary Care Practice Demonstration” to support better coordinated care, improve health outcomes for patients, and evaluate effectiveness for doctors and health professionals.

Eight states were selected to participate in this demonstration and include Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. The demonstration will include 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 for up to 500 FQHCs and provide patient-centered coordinated care for up to 195,000 Medicare beneficiaries.

A demonstration currently under development and slated to begin January 1, 2012 is referred to as the “Independence at Home Demonstration” was authorized by the Affordable Care Act. The demonstration will test a delivery model that uses physicians and nurse practitioners to direct primary care teams to help certain Medicare beneficiaries in their home.

Participating practices will be responsible for providing comprehensive, coordinated, continuous, and accessible care to high-need populations at home and coordinate their healthcare across all treatment settings. The practices must also report on the quality measures used to monitor and evaluate the demonstration by using electronic health systems. Practices may share in any savings under the demonstration program if they specifically provide quality measures and achieve savings.

A new State plan option to go into effect by January 1, 2011 required by Section 2703 of the Affordable Care Act will take place with patients enrolled in Medicaid with at least two chronic conditions will now be able to designate a provider as a “health home” provider to help coordinate their treatments. States that implement this option will receive enhanced financial resources from the Federal government to support “health homes” in their Medicaid programs.

Today, many state Medicaid programs have developed medical home models and can receive reimbursement. While many of these models are physician-based, there is a growing movement towards interdisciplinary team-based approaches. The Medicaid “health home” program will be funded 90 percent by the federal government for the first 2 years for each state program.

CMS has also announced quality bonus payments to be part of their three year demonstration for Medicare Advantage plans in 2012. All Medicare Advantage plans with a score of three stars or higher will qualify for a bonus payment and they if they earn the highest performance ratings then they are eligible to receive the largest bonuses of 5 percent.