CMMI Model. Leslie Welsh Flaherty Offices of Enterprise Management MES Conference

Transcription

1 CMMI Model Leslie Welsh Flaherty Offices of Enterprise Management 2013 MES Conference

2 Center for Medicare and Medicaid Innovation (CMMI) The Innovation Center Purpose: Test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid and CHIP while preserving or enhancing the quality of care furnished. The Innovation Center works and consults with a diverse group of stakeholders, including hospitals, doctors, consumers, payers, states, employers, advocates, relevant federal agencies and others, to obtain input and build partnerships for its work.

3 Offices of Enterprise Management (OEM) Purpose: Ensure a unified Agency approach to implement the CMS Strategy. OEM is the Agency s change agent to better align CMS resources and reduce operating costs to achieve improved healthcare quality and experiences of the people CMS serves across the Agency s line of business. Through commitment to agency-wide operational excellence and enterprise management, OEM thinks globally leveraging e-health standards and operating rules, data analytics, performance management, business architecture, project planning, and the new health focused research and development center. OESS OIPDA OEB OEP The Innovation Business Support Group, in collaboration with the Centers and Offices within CMS, participates in the integration of Strategic Information Systems and Innovation Center initiatives to support the CMS programs. 3

4 Innovation Center Models Accountable Care: e.g., Accountable Care Organizations (ACO); Comprehensive ESRD Care (CEC). Bundled Payments for Care: e.g., Bundled Payments for Care Improvement Initiatives (BPCI); Acute Care Episode Demonstration (ACE). Primary Care Transformation: e.g., Comprehensive Primary Care (CPC); Multi-Payer Advanced Primary Care Practice (MAPCP). Initiatives Focused on the Medicaid and CHIP Population: e.g., Strong Start for Mothers; Medicaid Emergency Psychiatric Demonstration. Initiatives Focused on the Medicare-Medicaid Enrollees: e.g., Financial Alignment Initiative for Medicare-Medicaid Enrollees; Initiatives to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models: e.g., Health Care Innovation Awards (HCIA); State Innovation Models (SIM) Initiatives to Speed the Adoption of Best Practices: e.g., Community-based Care Transitions Program (CCTP); Million Hearts. 4

5 Models: Medicaid and CHIP Populations Comprehensive Primary Care (CPC): 497 practitioners across 7 selected localities to transform primary care. AR, CO, NJ, Hudson Valley, Cincinnati-Dayton, Tulsa, and OR Strong Start for Mothers: 27 awardees testing 3 evidencebased maternity care service approaches. AL, AZ, CA, DC, FL, GA, IL, KY, MD, MI, MO, MS, NJ, NV, OK, PA, PR, SC, TN, TX, VA State Innovation Models (SIM): 25 States to test new payment and service delivery models. Test: AR, MA, ME, MN, OR, WA Pre-Test: CO, NY, WA Design: CA, CT, DE, HI, IA, ID, IL, MD, MI, NH, OH, PA, RI, TN, TX, UT

6 Model Phases CMMI Models: Idea/Concept Ini4a4on Planning and Design Solicit and Build Run, Evaluate, and Scale*** Closing

7 Run, Evaluate, and Scale Immediate access to timely, accurate and complete Medicaid and CHIP data to support program, evaluation and analysis needs.

8 Tick Tock Scotty Time A given time unit and they're told they have the same number of a smaller time unit. "I need five hours!" "You've got five minutes."

9 CMS Data CMS data is typically categorized according to contents: Beneficiary Level Medicare FFS Claims Beneficiary Level Medicare Enrollment Facility, Regional, and Other Summarized FFS Medicaid and CHIP Facility Pa4ent Assessment Part C&D Provider Survey Linked Accessible non CMS

10 Medicaid Data Today SSA D MF E D B Right Censored Date of Death Data Via DOD Auxiliary File Verify SSN & Dual Status State Medicaid Agencies MSI S.ST BK F iles MSI S.VAL I D F iles MAX State Summary D ata Marts Beta MAX EDB Enrollment Database Beta MAX Medicaid Analytic Extract Beta MAX Early Release MAX MSIS Medicaid Statistical Information System SSA DMP Social Security Administration Death Master File

11 Short to Mid-Term Leverage existing CMS data centers and data sets. MAX, Beta-MAX, Medi-Medi Leverage other sources and utilize new tools. Data enclaves Collaborate across CMS Centers and Offices in support of T-MSIS. Prioritize States whose data are needed sooner in support of active models

12 Accomplishments and Artifacts Environmental scan to identify potential data sources, e.g., Pursued interim stop gap measures to meet program needs by accessing Beta-MAX and Duals Demonstration data Cross collaboration to identify all possible data sources Extended the knowledge about Medicaid and CHIP data sources Review systems and shared services including proactive approach to accommodate Medicaid data, e.g., Creation of data enclaves Master Data Management Enterprise Shared Service enhancements

13 Collaboration Short to Mid-Term OEM and CMMI collaboration with Centers for Medicaid and CHIP Services (CMCS) Duals Office (MMCO) Center for Medicare (CM) Center for Program Integrity (CPI) Center for Clinical Standards and Quality (CCSQ) Office of Information Services (OIS) Office of the Actuary (OACT) Office of Financial Management (OFM) Other Federal Agencies States Private Sector Others

14 MACBIS and T-MSIS Medicaid and CHIP Business Information Solutions (MACBIS) Transformed MSIS (T-MSIS) The Centers for Medicare and Medicaid Services (CMS) implemented the T-MSIS initiative in an effort to receive more complete and timely Medicaid and Children s Health Insurance Programs (CHIP) related data from states. This initiative seeks to reduce the burden on states of multiple requests for data, allowing states to better perform its responsibilities of Medicaid and CHIP program oversight, administration, and program integrity. T-MSIS modernizes and enhances the way states will submit operational data about beneficiaries, providers, claims, and encounters, and will be the foundation of a robust state and national analytic data infrastructure.

15 CMS Informa2on

16 Links to Information Center for Medicare and Medicaid Information (CMMI): Each page lists the 7 types of models and those active Hover over each model to learn more and link to model-specific website information Research, Statistics, Data & Systems Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office (MMCO)): MedicaidCoordination.html Center for Medicaid and CHIP Services (CMCS): Center for Medicare (CM): CMS Data Navigator: Health Data: 16