A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Urban Institute and RWJF report explores the first year of CMMI

Posted on February 2, 2012 | No Comments

PDF Version
Details
Implementation Briefs
Key Developments
Library

The Urban Institute, funded by the Robert Wood Johnson Foundation (RWJF) recently released, “The Center for Medicare and Medicaid Innovation: Activity on Many Fronts,” which explores the first year of operation of the Center for Medicare and Medicaid Innovation (CMMI).  The paper argues that although CMMI has a long list of accomplishments, some observers express concern that its fast-paced approach may be overwhelming to smaller delivery systems.  The paper provides a comprehensive review of CMMI’s activities to date, including a survey of the goals envisioned by Congress.  The authors address CMMI’s major initiatives, including those that address primary care redesign, bundled payments, ACOs, dual-eligible beneficiaries, and the health care system’s capacity for spreading innovative ideas.

No Comments

Leave a Comment

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...
While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”
Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.
Historically, the Medicare program has passively purchased health care services for Medicare beneficiaries. Hospitals and other providers delivered services to Medicare beneficiaries and the Medicare program paid for the services without any indication of the quality or value of the care delivered. However, as costs have continued to escalate at an explosive pace without discernible improvements in the quality of care delivered, Congress and Medicare administrators have re-evaluated this passive payment methodology. Premised on the belief that the Medicare program must transition to be an active purchaser of high quality, cost-effective care, value-based purchasing uses financial incentives to both incentivize improved quality of care delivery and reduction of costs.
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.
An earlier Implementation Brief provided an overview of the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), which was established by §3022 of the Affordable Care Act (ACA) by adding §1899 to the Social Security Act. On April 7, 2011, the federal Centers for Medicare and Medicaid Services (CMS) published a proposed rule implementing the MSSP. This proposed rule was accompanied by several additional policy documents:
The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has formerly announced the Bundled Payments for Care Improvement initiative. This initiative, authorized by the Affordable Care Act (ACA), proposes that various provider reimbursements for multiple services a person may receive during the normal course of an illness or injury be bundled together into one payment. The initiative allows broad flexibility for providers to determine which services may be bundled, as well as what share of the single payment may be allocated to each provider. CMS intends for this initiative to improve care coordination and reduce costs in Medicare, and has issued a Request for Applications (RFA) from interested parties on the four (4) different proposed bundling models. For more information on bundled payments, click here.
A new report from the Department of Health and Human Services finds that the health reform law will save beneficiaries in traditional Medicare $3,500 over ten years from reduced drug costs, improved quality, and the elimination of fraud and abuse.
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).