“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.

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.

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.

Medicare Unveils New ACO Program

The federal Center for Medicare and Medicaid Innovation is launching a new accountable care organization (ACO) model through which providers can join together to serve Medicare patients.

The “Next Generation ACO” seeks to build on the experience, insight, and feedback gained through the Medicare Shared Savings Program and the Pioneer ACO model and give providers more tools for managing care and resources while also enabling them to take on more financial risk and earn greater financial rewards for doing so successfully.

A broader objective is to move Medicare closer to its stated goal of paying most providers based on the quality of care they deliver rather than on the quantity of services they provide.

The new model will have two risk tracks, one of which will be close to 100 percent risk, and a choice of four payment methodologies that will seek to facilitate a transition from fee-for-service to capitated reimbursement.  Those four payment systems are fee-for-service, fee-for-service with a monthly infrastructure payment, population-based payments, and capitated payments.

The Center for Medicare and Medicaid Innovation has created a number of resources through which interested parties can learn more about the new model:  a news release, a post on the blog of the Centers for Medicare & Medicaid Services (CMS), and a new web page devoted to the Next Generation ACO.

Parties interested in applying to become a Next Generation ACO must submit a letter of intent to the innovation center by May 1.

CMMI Holds Summit, Summarizes Activities

Created by the Affordable Care Act, the Center for Medicare and Medicaid Innovation (CMMI) shared information about the 14-month-old agency’s agenda and achievements to date at a “Care Innovations Summit” in Washington.

The agency is charged with responsibility for pursuing innovation in the delivery of care and payment for care to the Medicare and Medicaid populations as part of the broader health care reform effort.  It pursues its mission by identifying areas in which change is needed and then funding programs designed to test possible improvements.  Because urban safety-net hospitals serve so many Medicare and Medicaid patients, the implications of CMMI’s work are potentially great.

As part of the summit, the agency published a brief report, “One Year of Innovation:  Taking Action to Improve Care and Reduce Costs.”

CMMI will spend $10 billion supporting such initiatives through 2019.

The summit has its own web site, which you can find here.  A Department of Health and Human Services news release about the summit can be found here and a Washington Post article about the agency and the event is here.  CMMI’s own web site is hereHealth Care Reform/Flag, and the home page has a direct link to the new report.

States Seek New Ways to Manage Health Care Costs

As states continue to struggle with budget woes, they are getting more aggressive, and more ambitious, about finding ways to cut their health care costs – and they aren’t waiting for health care reform to kick in to get started.

Oregon, for example, hopes to introduce a new series of community health centers that would provide more integrated care to their patients.  At first the centers would serve only Medicaid and dually eligible (Medicare and Medicaid) patients, but eventually, state officials hope the clinics will serve public employees and teachers and possibly small businesses as well.  Read about Oregon’s plans in this Stateline report.

Massachusetts is focusing its attention on a narrower group:  chronically ill dual eligibles.  The state hopes to move 115,000 such individuals from its Medicaid fee-for-service program to managed care plans.  Learn more about Massachusetts’s plans in this Wall Street Journal articleA medical doctor standing with a confident smile.

With the federal government encouraging states to find new ways to serve their dual-eligible populations and the federal government, through the Affordable Care Act-created Center for Medicare and Medicaid Innovation (CMMI) providing seed money for such innovation, more states can be expected to begin testing new approaches to serving this population in the coming months.

Such new initiatives will undoubtedly have implications for urban safety-net hospitals, so NAUH will monitor their development and implementation closely.