Center for Medicare & Medicaid Innovation
Section 3021 of the ACA established the Center for Medicare and Medicaid Innovation (the Innovation Center), to fund, test and ultimately implement new models of health care delivery and payment for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). In order to realize its mission of “better care and better health at reduced costs through improvement,” the Innovation Center will provide $10 billion in direct funding between federal fiscal years 2011 and 2019 to selected partners through demonstration projects. CMS will take successful models to scale via rule-making, public-private partnerships and partnerships with states and local communities.
To date, the Innovation Center has engaged in a range of activities of interest to payers, providers, governments, and patients. For example, the Innovation Center:
- Hosts discussion sessions and webinars on a variety of topics, including surgical site infections, ACOs, and bundled payments
- Administers the Graduate Nurse Education Demonstration, which provides funding for hospitals to train advanced practice registered nursing (APRN) students
- Offers funding for innovative system delivery and payment models through the Health Care Innovation Awards
- Leads the Pioneer Accountable Care Organization (ACO) initiative
- Supports a Strong Start for Mothers and Newborns Initiative, which makes funding available for innovative approaches to prenatal care
- Trains leaders in healthcare innovation through its Innovation Advisors Program
- Sponsors a Bundled Payments for Care Improvement Initiative
- Invests in a Partnership for Patients program
- Promotes private payer investment in health care (including states) through its Comprehensive Primary Care Initiative
- Provides data and reporting on the success of CMMI and related initiatives.
The Innovation Center has also issued an ongoing, open solicitation for proposals regarding innovative system delivery and payment models.
Community Forums and Webinars
The Innovation Center hosts various community discussions and webinars on subjects relating to new health care payment models, such as bundled payments, ACOs, as well as clinical quality initiatives around issues, such as surgical site infections and end stage renal disease care. The Innovation Center also offers recordings of previously held “ACO Accelerated Development Learning Sessions” to provide support to existing or emerging ACO entities.
The Graduate Nurse Education Demonstration provides reimbursement to five hospitals for the reasonable cost of providing clinical training to advanced practice registered nursing (APRN) students in hopes of increasing the base of primary care providers in this country. Hospitals participating in the demonstration must partner with accredited schools of nursing and non-hospital community-based care settings. Under certain circumstances, hospitals participating in the demonstration may also partner with other hospitals in an effort to expand the number of APRN students trained. The demonstration, which began in July 2012, is expected to run for four years, with $50 million available annually.
Pioneer Accountable Care Organizations
On December 19, 2011, the Innovation Center announced 32 organizations to participate in the Pioneer ACO Model, an Innovation Center-led ACO initiative. The Pioneer ACO Model will test shared savings payment policies with higher levels of shared savings, and risk, than those levels proposed in the Medicare Shared Savings Program. In year three, Pioneer ACOs that reach a certain level of savings become eligible to move a “substantial portion” of their payments to a population-based model. Of the 32 original participants, 28 remain in the program.
Strong Start for Mothers and Newborns
Strong Start, which is a collaborative effort among CMS, other divisions of HHS and non-governmental organizations, promotes health among expecting women, new mothers, and newborns. As part of this initiative, CMS is making funding available for innovative approaches to prenatal care for women covered by Medicaid and at risk for preterm births. 182 organizations are currently participating in the Strong Start program.
Innovation Advisors Program
The Innovation Advisors Program will ultimately train up to 200 “Innovation Advisors” to test new models of care and service delivery in their home organizations. The program offers stipends of up to $20,000 to support the Advisors’ activities. As of December 2011, the Innovation Center had selected 73 Innovation Advisors, who started a six-month intensive orientation period in January 2012. Although the program intended to open for additional applications in Spring of 2012, no applications are currently available.
Bundled Payments for Care Improvement Initiative
The Innovation Center has launched a Bundled Payments for Care Initiative to test various models for bundling payments. Through this program, participants propose a target price for a defined episode of care, but are paid for services under the Medicare fee-for-service system at a negotiated discount. At the end of the episode, total payments are compared to the target price and participating providers share in the savings. Participants were announced on January 13, 2013, with applications for additional participants accepted between February 14, 2014 and April 11, 2014.
Partnership for Patients
The Partnership for Patients, a program through which the Innovation Center expects to invest up to $1 billion, aims to reduce hospital acquired conditions and decrease preventable complications that arise during transition from one care setting to another. Two main initiatives currently support these goals: (1) a Hospital Engagement Network, through which CMS awarded $218 million to “Hospital Engagement Networks” that identify pre-existing strategies that decrease hospital acquired conditions; and (2) a Community-Based Care Transitions Program, through which the Innovation Center expects to provide up to $500 million in funding for models that improve transitions from the hospital to other care settings and that reduce readmissions for high-risk Medicare beneficiaries. There are currently 3,700 hospitals participating in 26 Hospital Engagement Networks and 106 participants in the Community-Based Care Transition Program through the Partnership.
Comprehensive Primary Care Initiative
The Comprehensive Primary Care Initiative incentivizes private payers (including states) to invest in primary care. In order to achieve this goal, the initiative tests 2 models: (1) a comprehensive primary care service delivery model that emphasizes risk-stratified care management; access and continuity; planned care for chronic conditions and preventative care, patient and caregiver engagement; and coordination of care across the medical neighborhood; and (2) a payment model that includes a monthly management fee and, in fiscal years 2-4, the potential to share in savings to the Medicare program. Participants were selected as of August 22, 2012 and nearly 500 sites are continuing to participate.
Health Care Innovation Awards
Through the Health Care Innovation Challenge, the Innovation Center will award upwards of $1 billion in grants to projects that propose the “most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs.” Awards will range from $1 million to $30 million over 3 years, and applications are open to providers, payers, local government, public-private partnerships and multi-payer collaborations. The first round of awards went out on May 8, 2012 with additional awards made in the first round, totaling $122.6 million in awards. The 39 second round awards were announced on May 22, 2014 and July 9, 2014. The awards range from $2 million to $23.8 million over three years.
Data and Reports
In addition to promoting innovation through the numerous channels described above, the Innovation Center’s Data and Reports section is also tracking the progress and outcomes of those and other related efforts. The Innovation Center provides everything from final reports to Congress on the lessons from various demonstrations to ongoing evaluations of programs and initiatives still underway.
The Innovation Center is soliciting proposals for innovative system delivery and payment models that focus on one of three areas:
- Patient care models (e.g., bundled payment models);
- Seamless coordinated care models (e.g., innovations in accountable care organization); and
- Community and population health models (e.g., new models that impact obesity or smoking).
Once the Innovation Center identifies a model with promise, it will issue an “Innovation Partnership Opportunity” or “IPO” to select a partner(s) to test the model.