Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center

Transcription

1 Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center Healthcare IT Connect Sean Cavanaugh Deputy Director Center for Medicare and Medicaid Innova:on May 21, 2013

2 The CMS Innovation Center Identify, Test, Evaluate, Scale The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care furnished to individuals under such titles. - The Affordable Care Act 2

3 Rapid- Cycle Evalua'on Be part of the solu'on : Gather informa/on and leverage our claims data to promote and support con/nuous quality improvement in the marketplace. Speed: Improve our data systems and our ability to use data so that we can frequently and rapidly assess effec/veness and provide feedback to providers. Rigor: Use advanced epidemiologic methods to measure effec/veness to meet a high standard of evidence and allow for cer/fica/on. 3 3

4 Learning and Diffusion Integral part of every model team (1) Applying rigorous methods for rapidly studying and improving performance. (2) Applying innova/ve approaches to harvest, refine and spread what works (3) Bringing people together to learn from one another to accelerate the pace of change Ac/vi/es tailored for each ini/a/ve o ACO Accelerated Development Learning Sessions o Learning Infrastructure for Partnership for Pa/ents 4 4

5 CMS Innova'ons PorGolio Accountable Care Organizations (ACOs) Medicare Shared Savings Program (Center for Medicare) Pioneer ACO Model Advance Payment ACO Model PGP Transition Demonstration Comprehensive ERSD Care Initiative Primary Care Transformation Comprehensive Primary Care Initiative (CPC) Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration Independence at Home Demonstration Graduate Nurse Education Demonstration Bundled Payment for Care Improvement Model 1: Retrospective Acute Care Model 2: Retrospective Acute Care Episode & Post Acute Model 3: Retrospective Post Acute Care Model 4: Prospective Acute Care Capacity to Spread Innovation Partnership for Patients Community-Based Care Transitions Million Hearts Innovation Advisors Program Health Care Innovation Awards State Innovation Models Initiative Initiatives Focused on the Medicaid Population Medicaid Emergency Psychiatric Demonstration Medicaid Incentives for Prevention of Chronic Diseases Strong Start Initiative Medicare-Medicaid Enrollees Financial Alignment Initiative Initiative to Reduce Avoidable Hospitalizations of Nursing Facility Residents 5

6 Accountable Care Medicare Shared Savings Program (Center for Medicare) Pioneer ACO Model Advance Payment Model Accelerated Development and Learning Sessions Comprehensive ESRD Care Initiative 6 6

7 Geographic Distribu'on of ACO Assignees (Over 4 million total assignees in all programs) 7

8 Primary Care Comprehensive Primary Care (CPC) Initiative Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration Independence at Home Graduate Nursing Demonstration Medicaid Health Home State Plan Option 8

9 Comprehensive Primary Care Ini'a've 9

10 Federally Qualified Health Center (FQHC) Advanced Primary Care Demonstra'on 10

11 Bundled Payments for Care Improvement GOAL: Test payment models that link payments for multiple services patients receive during an episode of care for effectiveness in promoting coordination across services and reducing the cost of care. Four models: 1. Acute care hospital stay only 2. Acute care hospital stay plus post-acute care 3. Post-acute care only 4. Prospective payment of all services during inpatient stay 11

12 Bundled Payments for Care Improvement 12 12

13 Financial Alignment Initiative GOAL: Test two models for effectiveness in improving quality of care for Medicare-Medicaid enrollees and reducing costs to Medicare and Medicaid. Two Demonstration Models: Capitated Model: Three-way contract among State, CMS and health plan to provide comprehensive, coordinated care in a more cost-effective way. Managed FFS Model: Agreement between State and CMS under which States would be eligible to benefit from savings resulting from initiatives to reduce costs in both Medicaid and Medicare. Participating states: Massachusetts, Washington, Ohio 13

14 Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents GOAL: Test evidence-based interventions for their effec t i ve n e s s i n re d u c i n g p re ve ntable i n p atient hospitalizations among residents of nursing facilities. Participants implement evidence-based interventions at a minimum of 15 Medicare-Medicaid certified nursing facilities. 7 organizations selected to participate Interventions must: Improve beneficiary safety through coordinating management of prescription drugs Bring onsite staff to collaborate and coordinate with providers Demonstrate a strong evidence base 14

15 Capacity to Spread Innovation Partnership for Patients Community Based Care Transition Program Million Hearts Innovation Advisors Program Care Innovations Summit 15

16 Partnership for Patients GOALS: 40% Reduc'on in Preventable Hospital- Acquired Condi'ons 1.8 Million Fewer Injuries 60,000 Lives Saved 20% Reduc'on in 30- Day Readmissions 1.6 Million Pa/ents Recover without Readmission partnershipforpa/ents.cms.gov 16

17 Hospital Engagement Networks American Hospital Association Premier VHA NC Hospital Assoc Intermountain HealthCare GA Hospital Assoc TX Hospital Assoc MN Hospital Assoc NY State Hosp Assoc IA Healthcare Collaborative PA Hospital Assoc WA Hospital Assoc Dallas Fort Worth Regional Hospital Assoc OH Hospital Assoc NJ Hospital Assoc Ascension Health TN Hospital Assoc MI Hospital Assoc National Public Hospital & Health Institute Lifepoint Joint Commission Resources OH Children s Hospital Dignity Healthcare NV Hospital Assoc Carolinas Health Care University Health Care Collaborative 17

18 Community-based Care Transitions Program (CCTP) GOALS: Test models for improving care transitions from the hospital to other settings and reducing readmissions for highrisk Medicare beneficiaries Open to community-based organizations partnered with hospitals Currently 82 participants $500 million total funding Participants in all 10 CMS Regions 18

19 Ini'a'ves Focused on the Medicaid Popula'on Medicaid Emergency Psychiatric Demonstration Medicaid Incentives for Prevention of Chronic Diseases Strong Start Initiative 19

20 Health Care Innovation Awards GOAL: Test a broad range of innovative service delivery and payment models that achieve better care, better health and lower costs through improvement in communities across the nation. 107 Projects Awarded in 2012 Awards range from approximately $1 million to $30 million for a three-year period. Will impact all 50 states Second round announced May 15,

21 Health Care Innova'on Awards 21

22 State Innova'on Models GOALS: Partner with states to develop broad- based State Health Care Innova/on Plans Plan, design, test and support of new payment and service and delivery models in the context of larger health system transforma/on U/lize the tools and policy levers available to states Engage a broad group of stakeholders in health system transforma/on Coordinate mul/ple strategies into a plan for health system improvement 22

23 State Innova'on Models Awardees Model Testing States Arkansas Maine Massachusetts Minnesota Oregon Vermont Model Pre-Testing States Colorado New York Washington Model Design States California Connecticut Delaware Hawaii Idaho Illinois Iowa Maryland Michigan New Hampshire Ohio 23 Pennsylvania Rhode Island Tennessee Texas Utah (Announced 2/21/13)

24 State Innova'on Models 24 24

25 Where Innova'on is Happening 25 25

26 Thank You 26