CMMI must prove programs will save money

February 1, 2012

After drawing criticism from health reform opponents as a waste of money, the CMS Innovation Center must now justify its existence to Congress.

In its first year, the Innovation Center has launched projects designed to improve primary care, establish alternate Accountable Care Organizations (ACOs), test bundled payment models, coordinate care for dual eligibles and improve care in nursing homes and hospitals. CMMI Director Richard Gilfillan, former Geisinger Health Plan CEO, has brought in experts from health systems, academia and other Health and Human Services (HHS) offices to rapidly evaluate new strategies.

JUSTIFYING CMMI'S EXISTENCE

They also requested that the Government Accountability Office investigate CMMI implementation and its interactions with other HHS offices involved with testing new care and payment models. The Senators want an assessment of whether these activities will overlap and how they will be evaluated.

Several multipayer initiatives will test whether collaboration between private plans and public health programs can strengthen primary care and bolster Medicare and Medicaid. A partnership of some 3,000 hospitals seeks to reduce hospital-acquired infections and curb readmissions, both calculated to save money and improve care.

A lead project involves testing bundled payments for Medicare fee-for-service providers. This voluntary program, rolled out last August, aims to encourage collaboration by offering extra payments to groups that efficiently cover specified episodes of care.

Coordinating care for low-income seniors that receive coverage from both Medicare and Medicaid promises significant savings, as these patients tend to be heavy consumers of medical services. CMMI is testing models that offer global payments to health plans and state programs serving duals.

ACOs authorized by PPACA's Medicare shared savings program will emerge in coming months. Providers had balked at earlier proposals, and many health systems with their own ACO-like operations showed little interest in the Medicare approach. However, CMMI announced in December that the initiative will get off the ground with 32 healthcare organizations testing the ACO Pioneer program, designed for larger, more experienced organizations.

Still to come is the Advanced Payment ACO Model, which will offer support for small provider groups, especially those in rural areas, who want to test ACOs without assuming much risk.

To stimulate further delivery and payment proposals, CMMI is offering new awards and signing up dozens of "innovator advisors" to test and refine models.

Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.