As part of the Affordable Care Act, the Center for Medicare and Medicaid Services (CMS) established the Center for Medicare and Medicaid Innovation to test the ability of payment and delivery models to decrease costs and improve or maintain the quality of care.
Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
The Innovation Models are organized into seven categories.
- Accountable Care Organization (ACO)
Accountable Care Organizations and similar care models are designed to incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.
- Bundled Payments for Care Improvement
Medicare currently makes separate payments to various providers for the services they furnish to the same beneficiary for a single illness or course of treatment (an episode of care). Offering these providers a single, bundled payment for an episode of care makes them jointly accountable for the patient’s care. It also allows providers to achieve savings based on effectively managing resources as they provide treatment to the beneficiary throughout the episode.
- Primary Care Transformation
Primary care providers are a key point of contact for patients’ health care needs. Strengthening and increasing access to primary care is critical to promoting health and reducing overall health care costs. Advanced primary care practices – also called “medical homes” – utilize a team-based approach, while emphasizing prevention, health information technology, care coordination, and shared decision making among patients and their providers.
- Initiatives Focused on the Medicaid and CHIP Population
Medicaid and the Children’s Health Insurance Program (CHIP) are administered by the states but are jointly funded by the federal government and states. Initiatives in this category are administered by the participating states.
- Initiatives Focused on Medicare-Medicaid Enrollees
The Medicare and Medicaid programs were designed with distinct purposes. Individuals enrolled in both Medicare and Medicaid (the “dual eligibles”) account for a disproportionate share of the programs’ expenditures. A fully integrated, person-centered system of care that ensures that all their needs are met could better serve this population in a high quality, cost effective manner.
- Initiatives to Speed the Adoption of Best Practices
Recent studies indicate that it takes nearly 17 years on average before best practices – backed by research – are incorporated into widespread clinical practice—and even then the application of the knowledge is very uneven. The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption.
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
Many innovations necessary to improve the health care system will come from local communities and health care leaders from across the entire country. By partnering with these local and regional stakeholders, CMS can help accelerate the testing of models today that may be the next breakthrough tomorrow.