Archive for CMMI


CMS to Consider Model Behavioral Health Payment and Delivery Program

The Center for Medicare and Medicaid Innovation has invited interested parties to weigh in on the possibility of creating a new Medicare model program for behavioral health care delivery and payment.

According to a notice published in the Federal Register,

The Innovation Center is interested in designing a potential payment or service delivery model to improve health care quality and access, while lowering the cost of care for Medicare, Medicaid, or CHIP beneficiaries with behavioral health conditions. The model may include participation by other payers, qualify as an Advanced Alternative Payment Model (APM), improve health care provider participation in telehealth services, and address the needs of beneficiaries with deficits in care in the following potential areas leading to poor clinical outcomes or potentially avoidable expenditures: (1) Substance use disorders; (2) mental disorders in the presence of co-occurring conditions; (3) Alzheimer’s disease and related dementias; and/or (4) behavioral health workforce challenges.

The agency is hosting a public meeting at its headquarters in Baltimore in September to solicit ideas.

Learn more about the concept and the agency’s intentions in this Federal Register notice.…

Group Seeks Preservation, Reform of Federal Innovation Efforts

A coalition of 35 patient, physician, and hospital groups has written to new Secretary of Health and Human Services Tom Price and asked him to continue the federal government’s exploration of new ways to deliver and pay for Medicare services but to seek certain improvements in how those efforts are undertaken.

The coalition Healthcare Leaders for Accountable Innovation in Medicare asked Secretary Price for a reformed Center for Medicare and Medicaid Innovation so that it operates with

… appropriately-scaled, time-limited demonstration projects, greater transparency, improved data-sharing, and broader collaboration with the private sector.

The coalition also called for CMMI to operate under six guiding principles:

  • foster strong, scientifically valid testing prior to expansion
  • respect Congress’s role in making health policy changes
  • consistently provide transparency and meaningful stakeholder engagement
  • improve data sharing from CMMI testing
  • strengthen beneficiary safeguards
  • collaborate with the private sector

Read the coalition’s entire letter, including a list of the group’s members, here on the web site of the Healthcare Leadership Council.…

Medicare Unveils New ACO

The federal Center for Medicare and Medicaid Innovation is launching a new accountable care organization (ACO) model through which providers can join together to serve Medicare patients.

The “Next Generation ACO” seeks to build on the experience, insight, and feedback gained through the Medicare Shared Savings Program and the Pioneer ACO model and give providers more tools for managing care and resources while also enabling them to take on more financial risk and earn greater financial rewards for doing so successfully.

A broader objective is to move Medicare closer to its stated goal of paying most providers based on the quality of care they deliver rather than on the quantity of services they provide.

The new model will have two risk tracks, one of which will be close to 100 percent risk, and a choice of four payment methodologies that will seek to facilitate a transition from fee-for-service to capitated reimbursement. Those four payment systems are fee-for-service, fee-for-service with a monthly infrastructure payment, population-based payments, and capitated payments.

The Center for Medicare and Medicaid Innovation has created a number of resources through which interested parties can learn more about the new model: a news release, a post on the …

Innovation Center Reports to Congress

The agency created by the Affordable Care Act to invest in innovative approaches to delivering, improving, and paying for health care filed its annual report with Congress shortly before 2014 ended.

In all, the Center for Medicare and Medicaid Innovation has spent $2.7 billion of the $10 billion allocated to it in the 2010 reform law.  More than 60,000 providers and 2.5 million patients will soon be participating in programs launched under the innovation center’s auspices.

While the innovation center began awarding demonstration grants in 2011, it is generally considered too soon to draw conclusions about its successes and failures.  Among its better-known programs are initiatives to test accountable care organizations (ACOs), reduce injuries among hospital patients, and help federally qualified health centers (FQHCs) manage high-cost Medicare patients.

Kaiser Health News takes a closer look at the innovation center’s efforts, including the outcome of some of its programs so far; find its story here.  To see the innovation center’s report to Congress, go here.…

A Look at the Center for Medicare and Medicaid Innovation

A small but important part of the 2010 Affordable Care Act was creation of a new Center for Medicare and Medicaid Innovation (CMMI).  Allocated $10 billion, CMMI’s mandate is to pursue innovations in  health care delivery, quality, cost containment, and payment systems.

Just three years into its work, CMMI already has spent half of its $10 billion allocation on a variety of pilot projects, among them initiatives that seek to get hospitals and doctors to work more cooperatively; that encourage state-wide health system redesign; that attack cardiovascular disease; and that attempt to influence doctors to play a greater role in overseeing the care of the chronically ill.

For a closer look at CMMI, its mandate, and how it is going about its work, see this CQ HealthBeat report presented by the Commonwealth Fund.…