“Oh Say Can We See?”: Ways & Means Leaders Seek CMMI Transparency

The chairman and ranking member of the House Ways and Means Committee have written to CMS administrator Seema Verma to ask her to address the lack of transparency in the Center for Medicare and Medicaid Innovation.

In the bipartisan letter, committee chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX) note that “…Congress established CMMI to test different innovative delivery system and payment models to improve quality and reduce costs for Medicare and Medicaid beneficiaries” but observe that “…significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the health care community.

Their request:

We strongly urge the Agency to provide more sunshine in this process, all allow Congress, beneficiaries, and stakeholders greater opportunity to provide feedback into the policies that CMMI tests that affect millions of Americans with Medicare.

The letter also poses a series of questions about CMMI’s current endeavors.

Learn more from the letter from Representatives Neal and Brady to CMS administrator Seema Verma.

Medicaid Birthing Model Improves Outcomes

A federal program to improve birth outcomes among Medicaid-covered women has produced positive results:  lower rates of pre-term births, fewer low birthweight babies, fewer C-sections, lower delivery costs, and lower first-year health care spending.

The “Strong Start for Mothers and Newborns” program was a four-year initiative established by the Affordable Care Act and developed by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Innovation to employ patient education, nutrition, exercise, preparation for childbirth, breast-feeding, and family planning rather than strictly medical interventions and was delivered through three evidence-based prenatal care models:  Birth Centers, Group Prenatal Care, and Maternity Care Homes.

The program, operated in 219 separate sites in 32 states, served participants with especially challenging socio-economic risk factors:  unemployment, lack of a high school degree or GED, food insecurity, transportation challenges, chronic health problems, and previous poor birth outcomes.  The objective of the program was to find ways to overcome these social determinants of health and produce better birth outcomes and now, a new, independent evaluation has found that it did.

Learn more about Strong Start for Mothers and Newborns and what it has produced in the official program evaluation document.

Administration Moving Away From Value Pay?

First, new Medicare programs for lump-sums payments for cardiac care and joint replacements were scaled back.

Then, additional doctors were exempted from a new payment system that would have paid them more for the results they produce than for the quantity of care they provide.

Next, the Department of Health and Human Services presented a document outlining a new direction for its Center for Medicare and Medicaid Innovation.

And it announced that it was seeking input from doctors on payment policy.

All suggest that if the Trump administration is not moving away for paying for quality rather than quantity it is at least considering pursuing value in different ways.

What ways?  A recent article in the New York Times looked at these recent changes and presented the views of experts on where the administration may be going with Medicare payment policy.  Go here to see that article.

CMS Announces Drive to Reduce Paperwork

The Centers for Medicare & Medicaid Services is launching a new “Meaningful Measures” initiative that will seek to reduce the regulatory burden on health care providers.

According to a CMS news release, Meaningful Measures

…will involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes.  The agency aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes..

In a speech at the Health Care Payment Learning and Action Network, CMS administrator Seema Verma explained that this project will include moving the Center for Medicare and Medicaid Innovation in a new direction that promotes greater flexibility and patient engagement and implementing the Medicare Access and CHIP Reauthorization Act (MACRA) in ways that minimize the burden and cost of complying with the law’s requirements.

To learn more about this new CMS initiative, see this CMS news release or go here to read Ms. Verma’s remarks.

Group Seeks Preservation, Reform of Federal Innovation Effort

A coalition of 35 patient, physician, and hospital groups has written to new Secretary of Health and Human Services Tom Price and asked him to continue the federal government’s exploration of new ways to deliver and pay for Medicare services but to seek certain improvements in how those efforts are undertaken.

The coalition Healthcare Leaders for Accountable Innovation in Medicare asked Secretary Price for a reformed Center for Medicare and Medicaid Innovation so that it operates with

… appropriately-scaled, time-limited demonstration projects, greater transparency, improved data-sharing, and broader collaboration with the private sector.

The coalition also called for CMMI to operate under six guiding principles:

  • foster strong, scientifically valid testing prior to expansion
  • respect Congress’s role in making health policy changes
  • consistently provide transparency and meaningful stakeholder engagement
  • improve data sharing from CMMI testing
  • strengthen beneficiary safeguards
  • collaborate with the private sector

Read the coalition’s entire letter, including a list of the group’s members, here on the web site of the Healthcare Leadership Council.

Participation in Alternate Payment Models Rises

In 2017 nearly 360,000 clinicians will participate in Medicare and Medicaid Alternative Payment Model programs sponsored by the Centers for Medicare & Medicaid Services.

CMS also reports that this year 570 accountable care organizations, including 131 that bear risk, will serve more than 12.3 million Medicare and Medicaid beneficiaries.

In addition, nearly 3000 primary care practices will participate in advanced primary care medical home models.

Find more about the growth of participation in CMS’s alternative payment models, including descriptions of the different models and breakdowns in the numbers of participants, in this CMS news release.

Feds Launch Medicare-Medicaid ACO Model

The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says

…is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.

cmsIn this new model, the Innovation Center

… seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

The Innovation Center envisions pursuing such undertakings with six states, which will be chosen on a competitive basis.

Learn more about the Medicare-Medicaid Accountable Care Organization model here, on the Innovation Center’s web site.

Medicare’s Primary Care Demonstration Shows Promise

Medicare’s Comprehensive Primary Care Initiative produced encouraging results during its second year: 95 percent of the participating medical practices met their quality requirements and four out of the seven participating regions generated nearly $58 million in savings and will share those savings with Medicare.

cmsIn addition, the 481 participating medical practices reduced their overall admissions and readmissions rates, scores well on patient satisfaction surveys and quality measures, and surpassed national benchmarks in a number of areas, including preventive health measures.

The program will expand in 2017 with 14 new regions participating in Comprehensive Primary Care Plus, an enhanced version of the original program.

Learn more about the program’s 2015 results, the savings participating practices will share, and CMS’s plans for 2017 in this CMS blog entry.

New ACO Model Targets Social Determinants of Health

The federal government is altering a previously announced accountable care organization model to help it target the social determinants of health of the patients it serves.

The Accountable Health Communities model, launched by the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation in January, has been modified to target “community-dwelling Medicare and Medicaid beneficiaries with unmet health-related social needs.”

According to a CMS fact sheet,

The foundation of the Accountable Health Communities Model is universal, comprehensive screening for health-related social needs of community-dwelling Medicare, Medicaid, and dual-eligible beneficiaries accessing health care at participating clinical delivery sites. The model aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

  • Housing instability and quality,
  • Food insecurity,
  • Utility needs,
  • Interpersonal violence, and
  • Transportation needs beyond medical transportation.

Addressing the health-related associated with social determinants of health has long been one of the major challenges private safety-net hospitals face.

iStock_000005787159XSmallCMS anticipated participating ACOs serving their members through annual screenings of needs, increased dissemination of information about how to address health-related social needs, and appropriate referrals to community resources to meet those needs.

Among the organizations invited to apply to participate are community-based groups, health care organizations, hospitals and health systems, institutions of higher education, and government entities. In recognition of the need for a more patient-focused approach than CMS proposed in January, the number of members participating ACOs must serve has been reduced the potential award amount has been raised.

To learn more about the Accountable Health Communities model, why it has been modified, what it hopes to accomplish, and how it will operate, see this CMS fact sheet.

CMS Demonstration to Tie Medical, Service Needs

A new federal demonstration program will attempt to help low-income Medicare and Medicaid recipients gain access to services that ultimately will improve their health.

The Accountable Health Communities project, developed by the Center for Medicare and Medicaid Innovation and launched by the Centers for Medicare & Medicaid Services (CMS), is a $157 million demonstration program that

… aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

  • housing instability and quality
  • food insecurity
  • utility needs
  • interpersonal violence
  • transportation needs beyond medical transportation

cmsThe federal government intends to provide grants of up to $4.5 million to as many of 44 projects that pursue better ways to identify selected patients’ non-medical needs and connect those patients with available services in their communities. The grant funding will pay for the programs, not the services themselves, and will be evaluated to determine their impact on the health of program participants and the health care services utilization of those participants in light of the program’s central objectives of testing whether addressing the targeted needs will improve participants’ health and reduce their health care utilization.

For further information about the Accountable Health Community project, see this Kaiser Health News report; this CMS news release; this CMS fact sheet; and “Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid,” a New England Journal of Medicine article that describes the program, its goals, and its underlying rationale.