What We're Doing
The CMS Innovation Center has a number of initiatives and demonstrations underway that encourage better care and better health at lower costs through continuous improvement. Read a summary document of our efforts: One Year of Innovation: Taking Action to Improve Care and Reduce Costs (PDF) - through January 2012.
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.
Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. Medicare offers several ACO programs, including Shared Savings, Pioneer ACO, and Advance Payment.
An initiative for those ACOs entering the Medicare Shared Savings Program to test whether and how pre-paying a portion of future shared saving could increase participation in the Medicare Shared Savings Program.
Some providers have expressed a concern about their lack of ready access to the capital needed to invest in infrastructure and staff for care coordination. Under the proposed initiative, eligible organizations could receive an advance on the shared savings they are expected to earn as a monthly payment for each aligned Medicare beneficiary.
Testing a new payment and care delivery model for health care organizations and providers that are already experienced in coordinating care for patients across care settings.
This model allows these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program. The model is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.
Improving patient care through four models of payment innovation that foster improved coordination and quality through a patient-centered approach.
The CMS Innovation Center is seeking applications for four broadly defined models of care. Three models involve a retrospective bundled payment arrangement, and one model would pay providers prospectively. Through the Bundled Payments initiative, providers have great flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers.
A multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care for all Americans.
Primary care is critical to promoting health, improving care, and reducing overall system costs, but it has been historically under-funded and under-valued in the United States. Without a significant enough investment across multiple payers, independent health plans-- covering only their own members and offering support only for their segment of the total practice population-- cannot provide enough resources to transform entire primary care practices and make expanded services available to all patients served by those practices. The Comprehensive Primary Care initiative offers a way to break through this historical impasse by inviting payers to partner with Medicare investing in primary care among 5-7 selected localities across the country.
Testing the patient-centered medical home as a model to improve quality of care, promote better health, and lower costs.
This demonstration project, operated by the Centers for Medicare and Medicaid Services (CMS) in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to coordinate and improve care for up to 195,000 Medicare patients. Participating FQHCs are expected to achieve Level 3 patient-centered medical home recognition, help patients manage chronic conditions, as well as actively coordinate care for patients. To help participating FQHCs make these investments in patient care and infrastructure, they will be paid a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In return, FQHCs agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA). CMS and HRSA will provide technical assistance to help FQHCs achieve these goals.
Under the Graduate Nurse Education Demonstration, CMS will provide reimbursement to up to five eligible hospitals for the reasonable cost of providing clinical training to advanced practice registered nursing (APRN) students added as a result of the demonstration.
The primary goal of the demonstration is to increase the provision of qualified training to APRN students. The clinical training included in this demonstration will provide APRNs with the clinical skills necessary to provide primary care, preventive care, transitional care, chronic care management, and other services appropriate for Medicare beneficiaries.
Under this initiative, up to $1 billion dollars will be awarded to innovative projects across the country that test creative ways to deliver high-quality health care services and lower costs. Priority will be given to projects that rapidly hire, train and deploy new types of health care workers.
The Health Care Innovation Awards will support public and private organizations including clinicians, health systems, private and public payers, faith-based institutions, community-based organizations and local governments. Innovative approaches from these organizations that can begin within six months of award and demonstrate a model for sustainability post-award will also be given priority.
Under the Independence at Home Demonstration, the CMS Innovation Center will work with medical practices to test the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions. Additionally, the Demonstration will reward health care providers that provide high quality care while reducing costs.
Home-based primary care allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment, and assume greater accountability for all aspects of the patient’s care. This focus on timely and appropriate care is designed to improve overall quality of care and quality of life for patients served, while lowering health care costs by forestalling the need for care in institutional settings.
This new effort aims to improve the quality of care for people residing in nursing facilities.
CMS will support organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs. The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations. This initiative supports the Partnership for Patients
’ goal of reducing hospital readmission rates by 20% by the end of 2013.
A network of experts trained, supported, and charged by CMS to improve the delivery system for Medicare, Medicaid and CHIP beneficiaries.
The Innovation Advisors Program will inspire dedicated, skilled individuals in the health care system to deepen several key skill sets, including:
- Health care economics and finance
- Population health
- Systems analysis; and
- Operations research
The Medicaid Emergency Psychiatric Demonstration was established under Section 2707 of the Affordable Care Act to test whether Medicaid programs can support higher quality care at a lower total cost by reimbursing private psychiatric hospitals for certain services for which Medicaid reimbursement has historically been unavailable.
This demonstration will provide up to $75 million in federal Medicaid matching funds over three years to enable private psychiatric hospitals, also known as IMDs, to receive Medicaid reimbursement for treatment of psychiatric emergencies, described as suicidal or homicidal thoughts or gestures, provided to Medicaid enrollees aged 21 to 64 who have an acute need for treatment. Historically, Medicaid has not paid IMDs for these services without an admission to an acute care hospital first.
Program that awards grants to states to provide incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors.
The initiatives or programs are to be “comprehensive, evidence-based, widely available, and easily accessible.” The programs must use relevant evidence-based research and resources. An application by a State for a grant under the program must address one or more of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition.
A public-private partnership that offers support to physicians, nurses and other clinicians working in and out of hospitals to make patient care safer and to support effective transitions of patients from hospitals to other settings. The Community-based Care Transitions Program tests models for improving care transitions in order to reduce hospital readmissions.
The Partnership is an important part of the Center's work to improve the quality of care available to CMS beneficiaries. Thousands of providers across the country have already joined the partnership. The two goals of this new partnership are to:
1. Keep patients from getting injured or sicker.By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.
2. Test models for reducing hospital readmissions. The Community-based Care Transitions Program, for community-based organizations tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010.
The State Innovation Models initiative is a competitive funding opportunity for States to design and test multi-payer payment and delivery models that deliver high-quality health care and improve health system performance.
States will work with a broad coalition – employers, insurers, community leaders and service organizations, health care providers, consumers, tribal governments, among others – to design or test improvements to their health care delivery systems with the intent to improve care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries while eliminating unnecessary spending through these care improvements.
An initiative to improve health outcomes for mothers and infants across the country.
The Strong Start initiative includes two strategies:
Reduce Early Elective Deliveries:
A test of a nationwide public-private partnership and awareness campaign to spread the adoption of best practices that can reduce the rate of early elective deliveries before 39 weeks for all populations.
Delivering Enhanced Prenatal Care:
A funding opportunity for providers, States, and other applicants to test the effectiveness of specific enhanced prenatal care approaches to reduce pre-term births in women covered by Medicaid.