For more than a year, the Center for Medicare & Medicaid Innovation (CMMI) has worked to improve health care and reduce costs through a number of demonstration projects and programs that will increasingly need input from the long term care community to fully succeed, says Richard Gilfillan, director of CMMI, in an interview with Provider.
Created from President Obama's health care reform plan, CMMI works to put into action the broad designs of the Centers for Medicare & Medicaid Services (CMS) to rethink the way payment models are fashioned, among a host of initiatives underway or planned in the future. Gilfillan cites the Pioneer Accountable Care Organization (ACO) program and the Bundled Payments for Care pilot as examples of his group's forays into reshaping payment models and coordinated care.
The Pioneer program allows provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program, which was announced by CMS last year. The Pioneer model is designed to work in coordination with private payers by aligning provider incentives to improve quality and health outcomes for patients across the ACO and achieve cost savings for Medicare, employers, and patients.
CMS said the Pioneer ACO initiative to encourage primary care doctors, specialists, hospitals, and other caregivers to provide better, more coordinated care could save up to $1.1 billion over five years.
Last December, CMS announced that 32 organizations were selected to participate in the Pioneer ACO model. The first performance period began Jan. 1, 2012.
“This program really looks at all aspects of care for members and beneficiaries,” Gilfillan says, noting that long term care providers are part of the ACO program plans as care coordination extends to the entire care continuum and incentives are based on reducing hospital readmissions and tracking care to every setting.
The bundled payment pilot is not as far along as the Pioneer effort. CMMI is seeking applications for four broadly defined models of care. Three models involve a retrospective bundled payment arrangement, and one model would pay providers prospectively. Through the bundled payments initiative, providers have great flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers, CMS said.
Nursing homes and assisted living providers can prepare for possible inclusion in ACOs and other pilots by ramping up the technology they use to track care outcomes and resident health, Gilfillan says. “Certainly an EHR [electronic health record] is very helpful,” he adds. Besides EHRs, patient claims data is important to ACOs, acting as a link for all care providers.
Gilfillan says the good news for long term care is that physician groups and their doctors will be increasingly focused on residents in skilled nursing facilities. “The improvements to care will not be just in hospitals,” he says. “This is a great opportunity to improve care, to keep the patient in the safest place. A lot of attention will be paid to long term care, certainly.”
CMMI has attracted a lot of attention itself, with the number of ideas flowing to the center large and growing. The Innovation Challenge program has spurred a virtual avalanche of proposals from all corners of the health care sector, Gilfillan says.
The Health Care Innovation Challenge will award up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver health, improved care, and lower costs to people in Medicare, Medicaid, and the Children's Health Insurance Program.
“Providers care, and the word is out we are offering fertile ground to make care better,” he adds.
Learn more about the center at http://innovations.cms.gov/.