The Centers for Medicare and Medicaid Services (CMS) formally launched its innovations website, where it plans to gather and test new ideas to improve the healthcare system for its Medicare, Medicaid and Children’s Health Insurance Program (CHIP).
CMS will pilot models for coordinated care for patients, as well as shared payments for healthcare providers, in various real-world settings.
It will review submitted ideas, test and vet the evidence and select potential models that show promise for advancing better healthcare for individual patients, better health for the population and for reducing costs of care and monthly expenditures for Medicare, Medicaid and CHIP, said Peter Lee, CMS’ acting deputy director for policies and programs.
Established by the health reform law, the innovation center will study healthcare delivery methods for patient-centered, integrated care as an alternative to the current fragmented healthcare experience, where providers are paid piecemeal for clinical care, said Richard Gilfillan, MD, acting director of the innovation center.
“There is no shortage of innovation in healthcare in America,” Gilfillan said in an online presentation announcing the Web site March 21. He cited improvements in therapeutic and diagnostic technology, techniques and medical devices.
The center will call on consumers, patient groups, hospitals, clinicians and health plans to flesh out the models and then go through what would normally be a competitive bid process to partner with the innovation center, Lee explained.
Testing models
The innovation center will work with partners to test their models over six months, a year or two years and evaluate them for lessons “that we can learn right out of the gate,” he said.
“If models need to be modified because we learn something from three pilots that isn’t learned by the others, we’ll take those lessons and try to improve all of the systems that we’re testing,” Lee said. “If a pilot shows it doesn’t work, we will terminate it.”
CMS will begin to scale those models that demonstrate success. One way to spread them is for the Health and Human Services secretary to direct that they become part of the Medicare program for a particular period of time, or a rulemaking process could require use of the models.
“But spread will also happen, we believe, through the private sector – health plans and clinicians that we partner with – who say they are going to roll this out throughout the country through their own efforts, and not through federal efforts,” Lee said. “We think spread is going to happen through both routes.”
The Web site will provide access to a portfolio of criteria that models will need to meet.
“We don’t think that any one model that we’re going to test is going to address all that is in the portfolio,” Lee said.
He anticipates there will be dozens of models to make sure they tackle the needs of rural and urban communities and the range of clinician types and settings of care. Some models will generate short-term results in a year, while others will likely take three to five years.
