CMS Announces New Innovation Center, Multipayer Demonstration Project

A new CMS innovation center and a multipayer demonstration project, both of which were called for in the new health care reform law, are expected to promote the patient-centered medical home, or PCMH, model and to lead to better health care outcomes and lower costs in the U.S. health care system.

CMS officially launched the new Center for Medicare and Medicaid Innovation, or CMMI, and the Multi-Payer Advanced Primary Care Practice Demonstration during a Nov. 16 press conference.

The CMMI will be responsible for developing innovative health care and delivery models that will slow the growth of Medicare and Medicaid costs and that will improve quality. In this capacity, the CMMI will test variants of accountable care organizations, PCMH models and payment bundling -- all models of care that reward physicians for value rather than volume.

"The formal launch of the Center for Medicare and Medicaid Innovation paves the way for new models of delivering and paying for health care that will have goals of improving quality and safety of care and lowering costs," said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, in a press statement.

"The innovation center is integral to ensuring that the transformation of our health care delivery system is based on models that have effectively achieved improved patient outcomes, cost efficiencies and community health," he added.

The Multi-Payer Advanced Primary Care Practice Demonstration project will involve both the Medicare and Medicaid programs, as well as private insurance plans in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont. The project will evaluate the effectiveness of having physicians and other health care professionals work in a more integrated fashion across the health care system. Health care providers in the demonstration project also will receive coordinated payments from Medicare, Medicaid and private health plans.

The demonstration project is expected to eventually include up to 1,200 medical homes and to serve as many as 1 million Medicare beneficiaries, according to CMS.

"These initial pilot programs will move the nation toward comprehensive, coordinated health care for patients and away from our current fragmented, duplicative and costly sickness care model," said Goertz. "They emphasize the value of primary care as the keystone to a high quality, efficient health care system."

In a prepared statement, CMS Administrator Donald Berwick, M.D., commented on the need for the CMMI and the demonstration projects. "For too long, health care in the United States has been fragmented -- failing to meet patients' basic needs and leaving both patients and providers frustrated," said Berwick.

"Payment systems often fail to reward providers for coordinating care and keeping their patients healthy, reinforcing this fragmentation. The innovation center will help change this trend by identifying, supporting and evaluating models of care that both improve the quality of care patients receive and lower costs."

According to CMS, one of the missions of the CMMI is to consult stakeholders across the health care system, including physicians, hospitals, consumers, payers, states, employers, advocates, relevant federal agencies and others, to obtain direct input on its operations and to build partnerships with those interested in the center's work. The CMMI also will work with stakeholders to create learning communities that will help physicians and other heath care professionals rapidly implement new care models.

As part of that engagement, Berwick and Richard Gilfillan, M.D., a family physician and the acting director of the CMMI, met with stakeholders representing the health care industry, as well as consumers, states and employers, to discuss the CMMI and its planned activities.

According to AAFP Board Chair Lori Heim, M.D., of Vass, N.C., who participated in the roundtable discussion of stakeholders, CMS was asking for feedback. They wanted to know if they were on the right track and how best to engage us moving forward, said Heim.

Heim and other stakeholders at the meeting told CMS that the PCMH represents "the direction we need to move in, and the (PCMH) needs to be the basis for any accountable care organizations going forward."

The meeting also underscored the need for medical homes to involve multiple relevant stakeholders and not just governments or industry, Heim said. In addressing the multi-payer demonstration project, Heim said she emphasized the need for rapid feedback and data, something that is going to require coordination with CMS as well as private payers.

"If you are going to manage populations, you are going to have to get the data back (in a timely manner)," Heim said.