Commonwealth Fund Policy Brief on CMS State Innovation Models (SIM) Program

Since July 2012, the Centers for Medicare and Medicaid Services has awarded 25 states nearly $300 million to help them plan, design, and test new ways to improve population health and increase the value of health care services they pay for.

Under the State Innovation Models (SIM) Initiative, Oregon, for example, is promoting community-based networks of providers that receive a set fee to deliver a range of chronic disease management and health promotion services for Medicaid enrollees. Maryland, meanwhile, is extending its all-payer hospital rate-setting approach to all health care in a bid to hold cost growth below the state economy’s overall inflation rate.

A new Commonwealth Fund issue brief examines the early experiences of the SIM states, and offers lessons for other states wishing to pursue broad health system reforms while contending with formidable political and budgetary constraints.

Early Results from the CMS Innovation Center's CPCi

The Comprehensive Primary Care Initiative, launched last fall by the Centers for Medicaid and Medicare Services (CMS) Innovation Center, offers an opportunity for health plans, providers and CMS to work together on a community-based and integrated approach to health management. Preliminary year-one results for the Comprehensive Primary Care initiative appear to be positive, Managed Care Executive reports.

It looked at several CPCi sites, including Colorado. Patrick Gordon, associate vice president of Rocky Mountain Health Plans, the technical assistance contractor for CPCi on the Western Slope, shared some insights. It's a tough program, he says, but "nobody has thrown their hands up and said 'this is too much. In Colorado, a “very high percentage” of providers are meeting milestones and none of the 74 primary care practices or 369 providers in Grand Junction have exited the program.

Participants report that while aligning payment incentives is important, the real value of the Comprehensive Primary Care Initiative might be getting providers, payers, and government agencies to collaborate on pathways for information exchange.  Payment reform cannot be accomplished, nor will it solve the problems of our health care system, unless greater data exchange capabilities can be achieved.

Webinar Opportunity: Learn about $1 Billion in Innovation Awards Offered by the CMS Innovation Center

Prevention Institute, Public Health Institute and Trust for America’s Health will co-host a Dialogue4Health Webinar to provide information on a dynamic new funding opportunity offered by the Center for Medicare and Medicaid Innovation (CMMI). The webinar will take place on Thursday, June 13, from 11:30 am to 1:00 pm PST (2:30 pm to 4:00 am EST). Click here to register for this webinar, titled $1 Billion in CMMI Innovation Awards: Opportunities for Advancing Community Prevention and Population Health.

The Innovation Awards will support public and private organizations to develop and test new payment and healthcare delivery models that improve quality and reduce the costs of treating people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program. The funding announcement includes a category for “models that improve the health of populations.” This is a great opportunity to build momentum for the kind of health system transformation that will result in healthy people and places everywhere.

CMMI has invited a variety of innovators including providers, local governments, community-based organizations, payers, and health systems to apply, individually or as partners. During the webinar, speakers from the three organizations will discuss the opportunity for applicants to submit proposals to develop new payment models that advance and incentivize community prevention.

We hope this webinar will be a resource to potential applicants, as well as a forum for sharing and discussing cutting-edge ideas on what a community-centered health system could look like.

University of Michigan's VBID Center Info on CMS' SIM Program

CMS' State Innovation Model program is an important opportunity for local areas to align payers with each other, and with consumers to encourage the use of appropriate incentives, such as those used in value-based insurance design.  The University of Michigan's VBID Center has produced an Issue Brief on the SIM program's potential for advancing the use of VBID.  The Issue Brief includes a video overview and links to important CMS documents on the SIM program.

CMS Announces $1 Billion Health Care Innovation Awards Initiative

The Centers for Medicare & Medicaid Services (CMS) has released a Funding Opportunity Announcement for round two of the Health Care Innovation Awards. Under this announcement, CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

The second round of the Health Care Innovation Awards will support public and private organizations in four defined areas that have a high likelihood of driving health care system transformation and delivering better outcomes. Specifically, in this second round, CMS is seeking proposals in the following categories:

• Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings.
• Models that improve care for populations with specialized needs.
• Models that test approaches for specific types of providers to transform their financial and clinical models.
• Models that improve the health of populations – defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class – through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting.

In this round, CMS specifically seeks new payment models to support the service delivery models funded by this initiative. All applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model that they propose.

Interested parties of all types who have developed innovations that will drive significant improvement in population health, quality of care and total cost of care are welcome to apply. Eligible applicants include, but not limited to: provider groups, health systems, payers and other private sector organizations, faith-based organizations, states, local governments, public-private partnerships and for-profit organizations.

Key Dates and Deadlines
Letters of Intent to Apply: CMS will accept letters of intent beginning June 1 until June 28, 2013 3pm EDT.
Application: CMS will accept applications beginning June 14 until August 15, 2013 3pm EDT.

Visit the Innovation Center website for more details on how to apply for these awards! 

500 Primary Care Practices Announced for CMS Innovation Center Initiative

The CMS Innovation Center has selected five hundred primary care practices in seven geographic areas to participate in the Comprehensive Primary Care initiative. This represents over two thousand primary care doctors and nurse practitioners in seven markets across the country. NBCH has member coalitions in six of these seven geographic areas.

Under the Comprehensive Primary Care Initiative, CMS will pay primary care practices a care management fee to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members.

This four year public-private partnership is designed to test a model of improved access to quality health care at lower costs by aligning public and commercial insurance payment. The 500 practices were selected through a competitive application process and will start delivering enhanced health care services this fall.

Deadline Extended for CMS State Innovation Models Applications

As discussed on the All-Member Update Call on August 21, CMS, through the Innovation Center, is launching its State Innovation Models program. The State Innovation Models initiative is a $275 million competitive funding opportunity for States to design and test multi-payer payment and delivery models that deliver high-quality health care and improve health system performance. While States are the only parties that can apply, the program specifically envisions participation by all relevant stakeholders, including coalitions and purchasers.

Due to scheduled maintenance that will cause grants.gov to be inaccessible on September 17, the Innovation Center is modifying the State Innovation Models initiative application deadline as follows:

Applications for the State Innovation Models initiative are now due on Monday, September 24 by 5:00pm ET. This applies to all applications for Model Design awards and Model Testing awards.

CMS is also providing further clarification to States on the required financial templates for Model Design applicants. Model Design applicants should describe, if known, the anticipated cost savings and the return on investment for the overall state model and basis for expected savings.

Grants.gov is undergoing a migration from the Central Contractor Registration (CCR) to the System for Award Management (SAM). CMS strongly encourages states to check the grants.gov website to verify that their registration is current.

Upcoming Webinar: CMS Innovation Center staff will be hosting a webinar for state officials on Tuesday, August 28, 2012 from 3:00pm to 4:00pm ET to provide additional information on the application process, financial templates and accessing Medicare data. Register for the webinar here.  If you are unable to join, the slides, audio recording and transcript will be made available following the webinars.

Please contact Colleen Bruce for more information.

CMS Announces New State Innovation Models Initiative

The CMS Innovation Center has announced a new initiative for States to design and test improvements to their health care systems that would bolster health care quality and decrease costs. The State Innovation Models initiative is a competitive funding opportunity for States to join with other community stakeholders - including employers - to design and test multi-payer payment and delivery models that deliver high-quality health care and improve health system performance.

States can apply for either Model Testing awards which are intended to assist in implementing their already developed models, or states can apply for the Model Design awards that will provide funding and technical assistance as they determine what type of system improvements would work best for them. Up to five states will be chosen for the initial round of Model Testing awards and up to 25 states will be chosen for Model Design awards.

Applications are due September 17, 2012. CMS anticipates offering a second opportunity for all states to apply for a Model Testing award next year.  For more information, contact Colleen Bruce.

CMS Finalizes CPCi Agreements with Payers

In a strong show of support for more effective, more affordable, higher quality health care, 45 commercial, federal and State insurers in seven markets today pledged to work with the Centers for Medicare & Medicaid Services (CMS) to give more Americans access to quality health care at lower cost.

Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services. Simultaneously, participating commercial, State, and other federal insurance plans are also offering an enhanced payment to primary care practices that provide high-quality primary care.

Insurers in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma signed agreements with CMS to participate in this initiative. The markets were selected based on a diverse pool of applicants from commercial health plans, State Medicaid agencies, and self-insured businesses who hoped to work alongside Medicare to support comprehensive primary care.

In order to receive the new care management fee from CMS and insurers, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients’ other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

The list of insurers in each market can be found on the CMS Innovations Center website.

New initiative from Partnership for Patients aimed at improving hospital care

HHS announced a new program focused on providing hospitals across the country will new resources and support to make health care safer and less costly by targeting and reducing the millions of preventable injuries and complications from health care acquired conditions.

An initiative of the Partnership for Patients, a nationwide public-private collaboration to improve the quality, safety, and affordability of health care for all Americans, $218 million will go to 26 state, regional, national, or hospital system organizations. As Hospital Engagement Networks, these organizations will help identify solutions already working to reduce healthcare acquired conditions, and work to spread them to other hospitals and health care providers.

The 26 organizations receiving awards are:

The Innovation Center at One Year: Much Progress, More to Be Done

One year ago, the Center for Medicare and Medicaid Innovation was launched to find new ways to reduce costs and improve quality. As the National Scorecard on U.S. Health System Performance released last month by the Commonwealth Fund's Commission on a High Performance Health System shows, health care in the United States is the most expensive in the world, and the quality of care available to many Americans does not match that high level of spending. But the potential for achieving access to better care, as well as lower costs, exists—we already see it at work in select high-performing organizations and regions. Read the full post...

Health Care Innovation Challenge Update

The Health Care Innovation Challenge will award up to $1 billion in total grants to applicants who can rapidly implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs.

Upcoming Webinars – December 6th and December 13th:

To learn more about the Innovation Challenge, CMS Innovation Center staff will be hosting two additional webinars. The first webinar will be held on Tuesday, December 6th, 2011 at 2pm ET to provide guidance on the application process with specific attention towards project proposal design. A second webinar will be held the following week, Tuesday, December 13, 2011 which will delve deeper into the application process with special focus on quality measurement and financial plans. More information about the December 13th webinar will be posted on the Innovation Center website shortly.

WHAT: Webinar: Health Care Innovation Challenge: Project Design Discussion
WHEN: Tuesday, December 6, 2011 at 2:00pm – 3:45pm (EST)
WEBCAST: http://www.visualwebcaster.com/event.asp?id=83923

Participants wishing to listen to audio must dial 877-261-8937 and enter code 31613148#. Reminder, participants will only be able to ask questions via chat feature online. A recording will be available following the webinar.

***For more information, including a fact sheet, FAQs and the Funding Opportunity Announcement, please see the Health Care Innovation Challenge initiative web site at: www.innovations.cms.gov or send your questions to InnovationChallenge@cms.hhs.gov.

President Obama nominates Tavenner to take Berwick's post at CMS

The Obama administration on Wednesday nominated CMS principal deputy Marilynn Tavenner to replace outgoing administrator Donald Berwick, MD.

Berwick, in tandem, announced his resignation – which comes after a political impasse, in which Republicans effectively blocked a Senate confirmation. Read the full article...

Redesigning Healthcare Delivery Through Bundled Payments for Care

Q&A With Center for Medicare and Medicaid Innovation's Valinda Rutledge
On Aug. 22, CMS released a request for application for the Bundled Payments for Care Improvement Initiative. The initiative, created by the Patient Protection and Affordable Care Act, incents physicians and hospitals to coordinate care, which is intended to improve quality and reduce healthcare costs associated with treating Medicaid beneficiaries. For providers that are accepted, CMS will pay for an entire episode of a patient care, rather than pay for each service separately, and physicians and healthcare facilities will be able to share in any savings created by better coordinating care. Read the Q&A article...

Related: NBCH Webinar: Bundled Payments for Care Improvement (September 19, 2011)

Slides
Webinar Recording

Helpful Links –

• HCI3: Health Care Incentives Improvement Institute
• HOW HOSPITALS, PHYSICIANS, AND OTHERS CAN GET ORGANIZED TO PARTICIPATE IN CMS’ BUNDLED PAYMENT PILOT, By Alice G. Gosfield
• CMMI: Bundled Payments for Care Improvement (Fact Sheet, FAQS, Request for Application, Application information and materials)

New Deadlines: Bundled Payments for Care Improvement Initiative

Based on feedback and from the community of potential applicants and CMMI's continued commitment to work in partnership with stakeholders, the Innovation Center is modifying two deadlines for the Bundled Payments for Care Improvement initiative: 

• Model 1: 
• Letters of intent are now due on October 6th, 2011 
• Applications are now due on November 18th, 2011

For more information...

Related:

Materials and a recording are now available from Monday's NBCH Webinar: Center for Medicare/Medicaid Innovation (CMMI)- Bundled Payments for Care Improvement Featuring... Valinda Rutledge, Director, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services  Stephanie Milka, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services  Francois de Brantes, Executive Director, Health Care Incentives Improvement Institute

Message from Andy: Bundled Payments for Care Improvement

This is a follow-up to yesterday’s Member Alert on the announcement of the CMS bundled payment initiative. For members who were not able to make the conference call with Rick Gilfillan and other top officials with the Center for Medicare/Medicaid Innovation (CMMI), the call in number to hear the recorded conversation is: 800-642-1687; Conf ID 94307536.

Here is the CMMI web link where you can find the descriptions of the four bundled payment models discussed on yesterday’s call, the application form for submitting proposals to CMMI, and where to post questions: Bundled Payments for Care Improvement

In reviewing the application form, NBCH members should take particular note of two sections in the Table of Contents:

• Section II. F – Participation of Other Payers 
• Section III. A – Eligible Applicants 

These sections spell out the interest of CMS in engaging other payers in any one of the four bundled payment arrangements and the opportunity for a “convener facilitator” entity to play an organizing role without having to directly accept financial risk. 

Related Posts and Releases:

• HCI3 Update from the Field
• Hallelujah! - Today, Rick Gilfillan and Valinda Rutledge announced the CMMI's rollout of a national pilot to pay a bundle of services for a comprehensive episode of care. The plan is simple and elegant, broad and appealing, and builds on the successes of current CMS and private sector efforts. It's a huge step in the right direction and the CMMI should be commended and congratulated for this bold and innovative step.
• See Andy's Response to Francois in the "Transformation has Begun" Facebook Group

• HHS News Release: Affordable Care Act initiative to lower costs, help doctors and hospitals coordinate care
• The U.S. Department of Health and Human Services (HHS) today announced a new initiative to help improve care for patients while they are in the hospital and after they are discharged. Doctors, hospitals, and other health care providers can now apply to participate in a new program known as the Bundled Payments for Care Improvement initiative (Bundled Payments initiative).