Stephen A. Somers and Melanie Bella, Center for Health Care Strategies

Posted on May 14, 2010 | No Comments
Filed under Expert Commentary, Medicaid and CHIP, Medicare

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Never-Before Authority for Innovation

Throughout the health reform debate, when concerns about “true reform” of how we organize, finance, and deliver care arose, everyone seemed to look to the Center for Medicare and Medicaid Innovation (CMI) as the place that would provide the answers. Although that is a big expectation, CMI’s unprecedented authority is so broad and full of possibilities that those who care about Medicare and Medicaid could almost see it as a candy store or, as we have often said about Medicaid itself, a “land of opportunity.”

We say that, in large part, because Medicaid operates at the vortex of multiple public systems of care – i.e., physical health and behavioral health; child welfare and child health; and medical care and long-term supports and services – thereby creating numerous opportunities for dramatically improving care coordination, patient-centeredness, health care quality, and cost control. Perhaps CMI’s single largest opportunity for improvement is in the area with the greatest misalignment: care for those dually eligible for Medicare and Medicaid. The roughly nine million dual eligibles cost more than a quarter of a trillion dollars per year. All but approximately 100,000 of these beneficiaries are in separate and uncoordinated fee-for-service systems where fragmentation, duplication, and cost-shifting are the order of the day. CMI holds extraordinary promise for rapid innovation in this area. States and their partners are already lining up to get the green light to advance innovative models of care integration for dual eligibles that hold significant promise for improving care and controlling costs.

For all the promise to be realized, CMS will need to provide strong and fast-moving leadership. Congress expects action by early 2011 and results to be reported in 2012. All of us who are tracking progress in the true reform of our health care system have great expectations for this never-before authority.

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The Center for Medicare and Medicaid Innovation: A Year’s Progress

January 26, 2012

Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality. To foster the development of more collaborative and...

Dual-eligible Medicare/Medicaid Beneficiaries

August 10, 2011

According to the Centers for Medicare and Medicaid Services (CMS), in 2008 there were an estimated 9.2 million individuals who were eligible for and enrolled in both the Medicare and Medicaid programs (commonly referred to as “dual eligibles”). Two-thirds of dual eligibles qualify because they are over age 65, while the other third qualify because of a disability. Dual-eligible beneficiaries typically have multiple chronic conditions that require a higher level of care and result in increased spending relative to other Medicare and Medicaid beneficiaries; however, their care is not usually coordinated. Policymakers have expressed concern that the lack of coordination between the two programs results in higher costs and poorer health outcomes than would be achieved if Medicare and Medicaid services were better integrated.

Center for Medicare and Medicaid Innovation

May 13, 2010

Health reform establishes a Center for Medicare and Medicaid Innovation (CMI) and empowering and directing the CMI to “test innovative payment and service delivery models to reduce program expenditures under the applicable titles [Medicare and Medicaid] while preserving or enhancing the quality of care furnished to individuals under such titles.”

Commonwealth Fund issue brief details Innovation Center's mission and challenges faced

June 30, 2011

The Commonwealth issue brief, "Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change," reviews the mission of The Center for Medicare and Medicaid Innovation (Innovation Center) and provides perspectives from the research community on critical issues and challenges. This issue brief focuses on three requirements the Innovation Center must address to meet its objectives: 1) focusing on research-based changes that have the potential to achieve significant impact on improving quality and lowering costs; 2) documenting innovation testing and goals and tracking implementation and performances; and 3) generating evidence requisite to support broad-based policy change. To support these goals, the Affordable Care Act (ACA), has provided the Innovation Center with $10 billion in funding from 2011 to 2019. The intent is to allow quicker and more effective identification and spread of desirable innovations, with the goal of ultimately modifying Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Commonwealth issue brief addresses innovative payment approaches

June 30, 2010

The Center for Medicare and Medicaid Innovation, created by the Affordable Care Act (ACA), has a mandate to develop innovative payment models to improve health care delivery. The aim of this initiative is to achieve higher quality health care delivery and slower cost growth. The Commonwealth Fund Commission on a Higher Performance Health System's issue brief, "Developing Innovative Payment Approaches: Finding the Path to High Performance," discusses how the development, implementation, and evaluation of new care payment approaches can be improved, and how those improvements can help achieve the broader goals of health reform. The brief focuses largely on Medicare, but also considers how payment innovation pilots should not be limited to Medicare alone. Instead, payment innovations should also include Medicaid and the Children's Health Insurance Program (CHIP) to minimize the fragmented nature in which health care is provided.