Tuesday, January 3, 2012

CMS Creates New Programs

CMS has created a new demonstration program for chronically ill Medicare beneficiaries to test a payment incentive and service delivery system. The CMS Independence at Home (IAH) Demonstration is directed towards home-based primary care teams aimed at improving health outcomes and reducing expenditures. Participating practices must be available 24/7 to care out the care needed. Practices must use electronic health information systems, remote monitoring, and mobile diagnostic technology.

Services will be provided to high cost, chronically ill Medicare beneficiaries in their homes. Participating practices will need to provide comprehensive, coordinated, continuous, and accessible care to high-need populations at home and coordinate healthcare across all treatment settings. Participating practices may share in savings under the demonstration if specified quality measures and savings targets are achieved.

CMS is interested in finding practices that can provide home-based primary care and work as multidisciplinary teams composed of physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting staff.

Each participating practice must provide services to at least 200 applicable beneficiaries during each year of the demonstration. A practice’s enrollment may vary over each year but must reach at least an average of 200 applicable beneficiaries during the first year and not drop below that average for the remainder of the demonstration. There are three options available for practices when applying for the demonstrations. Practices may apply as a sole legal entity, consortium, or become a part of the national pools.

Applicable beneficiaries are defined as Medicare fee-for-services patients, who have at least 2 chronic illnesses, need assistance with two or more functional dependencies requiring the assistance of another person, have had a non-elective hospital admission within the last 12 months, and have received acute or sub-acute rehabilitation services within the last 12 months.

The demonstration is effective December 21, 2011 with provider applications to participate due February, 2012. For more information, contact Linda Colantino (410) 786-3343 or Jennifer Brown (410) 786-4036.

In another move, 32 healthcare organizations both rural and urban groups representing 18 states will participate in the new Pioneer Accountable Care Organizations (ACO) initiative. Through this program, the CMS Innovation Center will reward groups of healthcare providers within ACOs based on how well they are able to improve the health of their Medicare patients and lower their healthcare costs.

The initiative will test the effectiveness of several innovative payment models and how experienced organizations can provide better care for beneficiaries, work in coordination with private payers, and reduce Medicare cost growth. These payment models will enable organizations if they are successful to lower cost growth and to move away from a payment system based on volume under the FFS model and move towards one where the ACO is paid based on the value of care it provides.