CMS highlights delivery system initiatives

Speaking Jan. 26 at the Care Innovations Summit in Washington, D.C., Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, expressed the need to press forward with the “triple aim” goals of better individual health care, better population health and lower costs called for in the health reform law.

In 2014, most of the reform provisions of the Patient Protection and Affordable Care Act (ACA) go into effect and “24 months is not a lot of time” to get all the work done and fit the pieces together, she said.

Tavenner, a nurse and former Virginia Secretary of Health and Human Resources, awaits Senate confirmation as CMS administrator. She had been principal deputy administrator under Donald Berwick, MD, who stepped down last month from the agency’s lead role.

“The law was meant to build on our current system. We know what’s working and what needs improvement, and this law is the first step to make those changes in insurance company abuses, improving quality and lowering costs, better access to care and a doc fix for Medicare,” she said at Care Innovations event. The summit was hosted by CMS, West Wireless Health Institute and the journal Health Affairs.

CMS sees coordinating care and improving technology as two critical goals and is depending on its Innovation Center over the next 24 months to focus on changes in delivery models and the use of public/partnerships to spur reform.

The Innovation Center has launched delivery system initiatives to help test new models, such as accountable care organizations and medical homes with shared savings and bundled payments, and anticipates scaling nationwide what works.

Tavenner listed some ACA accomplishments to date, including filling in the prescription coverage “doughnut hole” with $250 rebate checks to Medicare recipients, creating a high-risk pool for those denied insurance or extremely high risk making insurance unaffordable, and a consumer website at that offers an insurance plan finder.

ACA has expanded coverage for young adults so parents can keep children to age 26 on their plan, she said. The law also expanded preventive services without co-pays, like flu shots and mammogram screening, which will help to lower costs over the long term.

If the Innovation Center tests a promising practice that demonstrates improvement in total cost of care and quality outcomes, the Office of the Actuary can certify that this initiative meets the criteria to be spread nationally through action by the secretary of Health & Human Services, said Dr. Rick Gilfillan, director of the CMS Innovation Center.

Some innovations run counter to the prevailing business models. “We know that providers will adopt these new practices only if they see value in them for themselves and for their patients,” Gilfillan said.

Among the Innovation Center initiatives to date:

  • Multi-payer Advanced Primary Care Practices Demonstrations led by eight states to help physicians become medical homes

  • Bundled Payment for Care Improvement Initiative for episodes of care around hospitalization for care redesign

  • Pioneer Accountable Care Organization Model Initiative with 32 provider groups taking on financial risk for improving quality and lowering cost for Medicare patients

  • State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees with 15 states redesigning care for dual eligible

  • Innovation Advisors Program to train 73 providers in achieving the three-part aim

  • Partnership for Patients with 3,200 hospitals targeting 40 percent reduction in hospital-acquired conditions and 20 percent reduction re-admissions within 30 days of discharge.

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