SEC. 3021 of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMI) within CMS. The purpose of the CME is to establish demonstration projects (i.e. tests) of innovative payment and service models that improve the quality, coordination and efficiency of services and reduce expenditures.
CMS may consult with Federal agencies or external parties with its commitment to open door forums. The types of models to be tested by CMI may include:
a) Promoting broad payment and practice reform for primary care.
b) Promoting innovative delivery models through risk-based comprehensive or salary payments with groups of providers or services/suppliers.
In general, these models should apply to geriatric patients with multiple chronic conditions that would benefit from services that include care coordination between providers and suppliers. These models may also support care coordination for patients with high risk of hospitalization. The model could support a chronic disease registry and home tele-health technology.
Other characteristics of models initiated by CMI may include payment variations to physicians based on appropriateness of services, using medication services described in section 935 of the Public Health Service Act, and using community-based health teams to support small-practice medical homes.
Additional factors include consideration for monitoring and updating patient care based on the needs and preferences of patients. In summary, goals of the CMI include improved quality of care and reduced spending. Other specifics of the CMI program may be found on CMI’s website.
As I am reading the goals of CMI, I can’t help but wonder about the influence successful tests may have on future healthcare regulations. In recent months, we have seen the following significant updates to Accountable Care (ACO) regulations. The following information was obtained from the CMS website at http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html