Our Process

Clinicians, health systems, and community leaders throughout the country are developing new models to provide better health and better health care at lower costs. We want to partner with these innovators to help them succeed, in particular by testing new ways to pay for services that foster improvement.

Solicit Ideas for New Models

There is a great richness of innovation occurring in local communities, states, and the private sector. Clinicians, health systems, community leaders, and other innovators throughout the country are developing new models of care that may be fostered by changes in payment to provide better health and better healthcare at lower costs. We want to hear about and learn from your great work and partner with you to transform the healthcare system.

Select the Most Promising Models

The Innovation Center will review payment and service delivery models submitted through the web form and will evaluate them against the Innovation Center Portfolio Criteria. The review process will include input from across CMS, HHS, other Federal partners and an array of external stakeholders.

Once the Center identifies payment changes or service delivery models that show promise and are ready for testing, the Center will determine the appropriate payment methodology, identify the appropriate performance measures and the means to collect them, consider how to engage beneficiaries, and identify technical assistance or learning opportunities that sites might need to implement the model. We may use additional “Requests for Innovation and Input” and listening sessions to allow the public and stakeholders to help us hone ideas into testable models. 

Test and Evaluate the Models

After selecting a promising model and refining it, the Innovation Center will solicit partners to test the model through mechanisms such as issuing a competitive “Innovation Partnership Opportunity” (IPO). IPOs may include competitive processes such as Requests for Applications, Requests for Proposals or tools to solicit ways for clinicians or others to partner with the Innovation Center. IPOs will be posted on the Innovation Center’s website. The specific selection process of partners to test each model will vary, but in all cases the competitive process will:

  • Be open and transparent, providing opportunities and mechanisms for potential partners to ask questions
  • Provide ways for the Innovation Center to share information regarding our expectations
  • Rely on multi-stakeholder expertise and community engagement to select the most qualified partners

The Innovation Center will work closely with our partners as they implement new models. States and other payers will be invited to collaborate with us in testing models. The Innovation Center will engage in rigorous evaluation of models to assess the overall impact of a model and identify for which beneficiaries and under what conditions the model performs best. Models will be carefully monitored during the testing phase and participants will be required to share data that can inform the Innovation Center’s understanding of how best to implement similar models and what modifications might be needed. In addition, all partners in Innovation Center efforts will be expected to participate in learning activities to share lessons learned from their care or payment model to improve their programs and in order to contribute to continuous system improvement.

The Innovation Center evaluation strategy focuses relentlessly on results requiring all models to meet the aims of – better healthcare, better health and reduced cost through improvement. Models may be modified or adjusted as they proceed based on lessons learned and statutory criteria. In addition, the Innovation Center will identify clear, objective benchmarks that, if not met, will lead to the termination of the testing and evaluation of a model.

Spread Successful Models

The Innovation Center will spread successful models through a variety of mechanisms. Under the legal authority that established the Innovation Center, the Secretary of Health and Human Services may, through formal rule-making processes, expand the duration and scope of a successful payment or delivery model that meets cost and quality tests to the entire Medicare, Medicaid, or CHIP programs. This process will allow CMS to speed the expansion of successful payment and delivery system changes more broadly through the Medicare, Medicaid, and CHIP programs.

In addition, the Innovation Center will employ a number of other methods for taking best practices to scale, including:

  • Sponsoring structured learning activities (e.g., learning collaboratives, campaigns)
  • Partnering with states, the private sector, and local communities
  • Publicly reporting our results
  • Publishing results in peer-reviewed and other journals
  • Hosting an electronic community of innovators through the Center’s website