Sunday, July 31, 2011

CMS Plans for Innovation

Delivering healthcare today is difficult because many people lack insurance, services are uncoordinated, and payment models need to be changed, noted Richard Gilfillan, MD, Acting Director for the CMS Center for Medicare and Medicaid Innovation (CMMI). He was a presenter at the first Annual ATA Policy Summit held July 27, 2011 in Washington D.C.

CMMI was funded with $10 billion to provide better healthcare, better health, and lower costs. The Center has a funding advantage since the HHS Secretary can expand successful models without going back to Congress for more funding.

As Dr. Gilfillan explained, the agency is soliciting ideas for new models and plans to test, evaluate, and select the most successful models. Once the new models of care are selected, CMMI will solicit partners to test the model by issuing a competitive “Innovation Partnership Opportunity” (IPO). The IPOs may include competitive processes such as Requests for Applications, Requests for Proposals, or other ways to solicit clinicians or others to partner with the Innovation Center. IPOs will be posted on the CMMI website.

The Administration’s new nationwide patient safety initiative “Partnership for Patients” (PFP) created by ACA, now has over 2,000 hospitals pledging their support for the program. With the collective effort of private and public stakeholders, the program aims to reduce preventable harm in hospitals by 40 percent over the next three years.

According to Gilfillan, right now, the PFP initiative has the potential to save up to $35 billion in healthcare costs, including up to $10 billion for Medicare. Over the next ten years, the initiative could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.

So far, two PFP funding opportunities have been created:

• Community-Based Care Transitions Program provides up to $500 million in funding for community-based organizations in partnership with hospitals to help patients safely transition between settings of care. Applications are accepted on a rolling basis. Go for more information

• CMS posted a request June 17th with added information on June 20th for bids to find state, regional, national, or hospital system organizations to manage improvement projects. The solicitation (APP111513) is soliciting a Hospital Engagement Contractor to support the program. CMS intends to award multiple contracts by September 30, 2011. For more information, go to or

HHS recently announced several new models to help states. One demonstration program is going to test two new financial models to help states better coordinate care, another demonstration program will help states improve the quality of care for people in nursing homes by enabling these individuals to receive the care they need without necessarily going to a hospital, and a new initiative to make a technical resource center available to states to help them improve care for high-need high-cost beneficiaries.

In addition, CMS is helping states better coordinate care for individuals enrolled in both Medicare and Medicaid. Also, a new model would enable a state, CMS, and health plans to enter into three-way contracts where the managed care plan would receive a prospective blended payment to provide comprehensive and coordinated care.

CMMI through their new “Community and Population Health Models” initiative is going to test care and payment models to improve public health especially in the case of smoking and obesity issues. The Center will work with other organizations to test new care and payment models that will impact the underlying drivers of health for Medicare, Medicaid, and CHIP.

For more information on the initiatives, go to