CMS innovation center to test new payment models

By Mary Mosquera
10:15 AM

The Centers for Medicare and Medicaid Services has opened the doors to its innovation center, where it plans to test models of coordinated care for patients as well shared payments for healthcare providers in various real-world settings.

The Center for Medicare and Medicaid Innovation, called for in this year's health reform law, will study healthcare delivery methods for patient-centered, integrated care as an alternative to today's fragmented healthcare experience, where providers are paid piecemeal for clinical treatments.

"Payment systems often fail to reward providers for coordinating care and keeping their patients healthy, reinforcing this fragmentation," said CMS administrator Donald Berwick, during a Nov. 16 briefing. The innovation center will help change this trend, he added.

In its first efforts, CMS will invite states to apply for funds in December to develop demonstration projects for synchronizing care for "dual-eligible" persons, those who are eligible for both Medicare and Medicaid benefits, Berwick said. 

$15 million for state programs

The innovation center expects to award up to $1 million each in design contracts to as many as 15 state programs.

People who are eligible for both programs account for 16 percent to 18 percent of enrollees in Medicare and Medicaid and about 25 to 45 percent of spending in these programs respectively.  Significant health benefits and savings can result from coordinating the care of low-income seniors and people with disabilities he said.
To help direct the innovation center, it will work cooperatively with providers, payers, consumers and federal agencies involved in delivering healthcare, said Richard Gilfillan, MD, acting director of the innovation center. He is former president and CEO of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System, a large integrated health system.

"We want to identify, validate, and scale models that have been effective in achieving better outcomes and improving the quality of care, but may be relatively unknown," Gilfillan said.

Technology important
Technology is an important foundation for innovation, but a lack of it does not preclude work in demonstrations, officials said. Electronic health records are a major asset in improvements in patient-centered care, the flow of health information and chronic disease management, Berwick said.

"But I think CMS should be fostering innovation in any setting, no matter at what level of technology they are at," he said.

Berwick said he is "thrilled by the progress that the country is making toward modernization of our healthcare information systems. I've seen how Stage 1 of meaningful use is taking hold and working our way to modernization over time," he said.
The center will also test models that include establishing an "open innovation community" that serves as a clearinghouse of best practices in healthcare innovation. CMS will take what it learns and share it so other providers can rapidly establish these new care models.

New initiatives
CMS also announced several new efforts to strengthen primary care in patient-centered, coordinated "health home" and "medical home" concepts. The efforts include:

  • The expansion of the multi-payer advanced primary care practice demonstration in which eight states will participate in evaluating the effectiveness of providers across the care system working in an integrated fashion and receiving payment from Medicare, Medicaid, and private health plans;
  • Creation of the Federally Qualified Health Center advanced primary care practice demonstration to test the results of clinicians working in teams to treat low-income Medicare patients at 500 community health centers; and
  • Launch of the Medicaid health home state plan through which patients enrolled in Medicaid with at least two chronic conditions will designate a provider as a "health home" to coordinate treatment. States that participate will receive increased payments.