Beneficiary Engagement Model Opportunities
In this initiative, CMS is seeking “innovative models to increase the engagement of Medicare beneficiaries, Medicaid beneficiaries, Medicare-Medicaid enrollees, and/or Children’s Health Insurance Program (CHIP) beneficiaries in their health and health care…using incentives and behavioral insights.” A Request for Information was put out in September 2014, but no further information is available.
Community-based Care Transitions Program
This initiative is meant to “test models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.” It mandates the use of Community-based organizations (CBOs) to coordinate the care of patients transitioning among settings using care transition services. The CBOs will be paid an all-inclusive rate per eligible discharge. CMS has allocated $300 million dollars for this initiative which is scheduled to run from 2012 to 2017.
Health Care Payment Learning and Action Network
The Health Care Payment Learning and Action Network was initiated to help advance the work being done across sectors to increase the adoption of value-based payments and alternative payment models. It will:
- Serve as a convening body to facilitate joint implementation of new models of payment and care delivery,
- Identify areas of agreement around movement toward alternative payment models and how best to analyze data and report on these new payment models,
- Collaborate to generate evidence, share approaches, and remove barriers,
- Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, quality and performance measurement, risk adjustment, and other topics raised for discussion, and
- Create implementation guides for payers, purchasers, providers, and consumers.
The Learning and Action Network (LAN) will be composed of payers, providers, employers, states, consumer groups, and individual consumers.
Innovation Advisors Program
This initiative is no longer active. It launched in 2011 to create “CMS Innovation Advisors.” Those who were selected received training and then engaged in “activities to deepen several key skill sets related to CMS strategy, population health and care redesign along with innovation and improvement science.” It is not clear whether those individuals are still involved in any way.
Medicare Imaging Demonstration
This initiative is no longer active. It was to “test whether the use of decision support systems (DSS) can improve quality of care and reduce unnecessary radiation exposure by promoting appropriate ordering of advanced imaging services.” The demonstration included eleven advanced imaging procedures -- Spect MPI, MRI lumbar spine, CT lumbar spine, MRI brain, CT brain, CT sinus, CT thorax, CT abdomen, CT pelvis, MRI Knee, and MRI shoulder and was conducted by an assortment of medical providers. A report of the results was published by the Rand Corporation in April 2014 with many suggestions for improving DSS.
The goal of this initiative is to “focus, coordinate, and enhance cardiovascular disease prevention activities across the public and private sectors and will scale-up proven clinical and community strategies to prevent heart attack and stroke across the nation.” The name comes from their goal of preventing one million strokes and heart attacks by 2017. It plans to do this by:
- Improving access to effective care.
- Improving the quality of care for the ABCS: Aspirin for those at risk for heart attack and stroke; Blood pressure control; Cholesterol management; and Smoking cessation.
- Focusing clinical attention on the prevention of heart attack and stroke.
- Activating the public to lead a heart-healthy lifestyle.
- Improving the prescription and adherence to appropriate medications for the ABCS.
Million Hearts: Cardiovascular Disease Risk Reduction Model
CMS describes this initiative as follows: “The MH Model is employs a randomized controlled design. CMS will enroll up to 720 practices into the model. Half of the enrolled practices will be randomized to the intervention group, and half to the control group. All practices will be eligible for additional funding for participation in the model.
Practices randomized to the intervention group will be asked to screen all eligible Medicare beneficiaries for their 10 year risk of a heart attack or stroke using the American College of Cardiology/American Heart Association (ACC/AHA) 10-year Atherosclerotic Cardiovascular Disease (ASCVD) pooled cohort risk calculator which uses several pieces of information, including age, gender, blood pressure, cholesterol level, smoking status, and a few other inputs. The tool gives each patient a personalized 10-year-risk percentage. For patients at the highest risk (defined as a risk over 30 percent of heart attack or stroke over 10 years), providers will receive a monthly per beneficiary Cardiovascular Care Management payment to reduce their practice wide absolute risk. This will be accomplished by using shared decision making, and will not target any specific numbers for blood pressure or cholesterol. Instead, CMS will reward based solely on reduction in predicted cardiac risk. All practices enrolled in the model will have the options of using their own system to calculate and track risk, or be given free access to a web-based tool.
Practices randomized to the control arm will be asked to report only clinical data (such as age, cholesterol level, and other information) on their attributed Medicare Beneficiaries at years 1, 2, 3, and 5 of the model. Control group practices will be paid a $20 per-beneficiary payment (based on the estimated costs of preparing and transmitting the required data) for each reporting cycle.
This study starts in January 2016.
Partnership for Patients
The Partnership for Patients and its participating hospitals are focused on making hospital care safer, more reliable, and less costly through the achievement of two goals:
- Making Care Safer. Keep patients from getting injured or sicker. Decrease preventable hospital-acquired conditions by 40 percent compared to 2010.
- Improving Care Transitions. Help patients heal without complication. Decrease preventable complications during a transition from one care setting to another so that hospital readmissions would be reduced by 20 percent compared to 2010
Key aspects of the program include The Hospital Engagement Networks, The Community-Based Care Transitions Program, and Patient and Family Engagement.