Healthcare Innovation: Implications for the Workforce

Healthcare Innovation: Implications for the Workforce

American National Standards InstituteBuilding a Qualified, Flexible and

Mobile Healthcare Workforce for the Future

Ellen-Marie Whelan, NP, PhD, FAANSenior AdvisorCenter for Medicare & Medicaid InnovationFebruary 11, 2014

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Thank You

• For the care you are providing every day

• For the hard work you are doing to improve your care systems every day

• For your commitment to health care reform, innovation and transformation

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We need delivery system and payment transformation

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PUBLICSECTOR

Future State – People-Centered

Outcomes Driven Sustainable

Coordinated Care Systems

New Payment Systems

Value-based purchasing

ACOs Shared Savings Episode-based

payments Care Management

Fees Data Transparency

Current State – Producer-Centered Volume Driven

Unsustainable

Fragmented Care Systems

FFS Payment Systems

PRIVATESECTOR

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What will cause the change?

• There is no “silver bullet”• Align service delivery and payment

models with desired outcomes• Provide data to empower rapid

learning• Demonstrate successful alternative

models• Provide intensive support• Learn how to scale and spread

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“The CMS Innovation Center

The purpose of the [Center] is to test

innovative payment and service delivery

models to reduce program expenditures…

while preserving or enhancing the quality

of care furnished to individuals under such

titles.

- The Affordable Care Act5

Identify, Test, Evaluate, Scale

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CMS Measures of Success

• Better care and lowers costs: Beneficiaries receive high quality, coordinated, effective, efficient care. As a result, health care costs are reduced.

• Improved Prevention and population health: All Americans are healthier and their care is less costly because of improved health status resulting from use of preventive benefits and necessary health services

• Expanded Health Care Coverage:All Americans have access to affordable health insurance options that protect them from financial hardship and ensure quality health care coverage.

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Our Strategy: Conduct many model tests to find out what works

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The Innovation Center portfolio of models

will address a wide variety of patient populations, providers, and innovative approaches to care and payment

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CMS Innovations Portfolio

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Accountable Care Organizations (ACOs)• Medicare Shared Savings Program (Center for

Medicare)• Pioneer ACO Model• Advance Payment ACO Model• Comprehensive ERSD Care Initiative

Primary Care Transformation• Comprehensive Primary Care Initiative (CPC)• Multi-Payer Advanced Primary Care Practice

(MAPCP) Demonstration• Federally Qualified Health Center (FQHC)

Advanced Primary Care Practice Demonstration• Independence at Home Demonstration • Graduate Nurse Education Demonstration

Bundled Payment for Care Improvement• Model 1: Retrospective Acute Care • Model 2: Retrospective Acute Care Episode &

Post Acute• Model 3: Retrospective Post Acute Care• Model 4: Prospective Acute Care

Capacity to Spread Innovation• Partnership for Patients • Community-Based Care Transitions Program• Million Hearts

Health Care Innovation Awards

State Innovation Models Initiative

Initiatives Focused on the Medicaid Population• Medicaid Emergency Psychiatric Demonstration• Medicaid Incentives for Prevention of Chronic

Diseases• Strong Start Initiative

Medicare-Medicaid Enrollees• Financial Alignment Initiative• Initiative to Reduce Avoidable Hospitalizations of

Nursing Facility Residents

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Accountable Care

Organizations

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Accountable Care Organizations

• Encourage and support physicians, hospitals, and other providers to lower costs by providing better quality care and rewarding success by allowing providers to share in the resulting savings.

• Goals for ACOs:– Give providers incentives to achieve savings and tools to help

coordinate and improve care, while assuring quality of care.– Assure patients get coordinated care, without overly

burdensome regulations. – Promote better coordination between primary care providers

and specialists.

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Quality Measurement & Performance for ACOs

• Quality measures (33) are separated into the following four key domains:– Better Care

1. Patient/Caregiver Experience2. Care Coordination/Patient Safety

– Better Health3. Preventative Health4. At-Risk Population

• Must meet quality targets to share in savings and amount of savings shared depends on quality performance 11

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“Bundled” payments

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Bundled Paymentsfor Care Improvement

Four models:

1. Acute care hospital stay only

2. Acute care hospital stay plus post-acute care

3. Post-acute care only

4. Prospective payment of all services during inpatient stay

GOAL: Test payment models that link payments for multiple services patients receive during an episode of care for effectiveness in promoting coordination across services and reducing the cost of care.

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Perinatal/ Medicaid Models

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Strong Start: Strategy 1

3 primary activities:

1. Promote Awareness – support broad-based awareness efforts in partnership with March of Dimes, American College of Obstetricians and Gynecologists, Childbirth Connection, and other organizations.

2. Spread Best Practices – building on efforts of Partnership for Patients to create measureable goals and provide technical assistance in testing and implementing a variety of strategies.

3. Promote Transparency – support efforts to collect performance data and measure success and continuous improvement.

GOAL: Test ways to encourage best practices and support providers in reducing early elective deliveries prior to 39 weeks.

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Strong Start: Strategy 2

• Testing 3 approaches to delivery of enhanced prenatal care

• Targets women receiving Medicaid and at risk for having a preterm birth

• Up to $43 million in funding to 27 awardees

• Awards will be located in 32 states, the District of Columbia and Puerto Rico, and will serve more than 80,000 women enrolled in Medicaid or CHIP over the 3 intervention years

GOAL: Test effectiveness of prenatal care approaches to reduce preterm births for women covered by Medicaid or CHIP who are at risk for preterm births

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Capacity to Spread

Innovation

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Partnership for Patients

40% G O A L S :

20%

Reduction in Preventable Hospital-Acquired Conditions1.8 Million Fewer Injuries | 60,000 Lives SavedReduction in 30-Day Readmissions1.6 Million Patients Recover without Readmission

partnershipforpatients.cms.gov18

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Partnership For Patients: Improving Patient Safety

• Design intensive programs to teach and support hospitals in making care safer

• Share best practices • Provide technical assistance for hospitals and care

providers• Establish and implement a system to track and monitor

hospital progress in meeting quality improvement goals. • Engage patients and families• 26 Hospital Engagement Networks

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GOAL: Decrease preventable hospital-acquired conditions by 40% in 3 years.

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Community-based Care Transitions Program (CCTP)

• Open to community-based organizations partnered with hospitals

• Currently 102 participants

• $500 million in total funding

• Participants in all 10 CMS Regions

GOALS: Test models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries

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State Models

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State Innovation Models

• Partner with states to develop broad-based State Health Care Innovation Plans

• Plan, Design, Test and Support of new payment and service and delivery models in the context of larger health system transformation

• Utilize the tools and policy levers available to states

• Engage a broad group of stakeholders in health system transformation

• Coordinate multiple strategies into a plan for health system improvement

GOALS:

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State Innovation Models Awardees

Model Testing States• Arkansas

• Maine

• Massachusetts

• Minnesota

• Oregon

• Vermont

Model Pre-Testing States• Colorado

• New York

• Washington

Model Design States• California

• Connecticut

• Delaware

• Hawaii

• Idaho

• Illinois

• Iowa

• Maryland

• Michigan

• New Hampshire

• Ohio

• Pennsylvania

• Rhode Island

• Tennessee

• Texas

• Utah

(Announced 2/21/13)23

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Innovation is happening broadly across the country

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Primary Care Models

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Federally Qualified Health Center (FQHC)

Advanced Primary Care Demonstration

• Open to FQHCs that have provided medical services to at least 200 Medicare beneficiaries in previous 12-month period.

• FQHC receives care management fee for each Medicare beneficiary enrolled.

• 485 FQHCs selected.

• Performance year started Nov 1st 2011.

GOAL: Evaluate impact of the advanced primary care practice model in the Federally Qualified Health Center (FQHC) setting.

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Independence at Home

GOAL: Testing the effectiveness of providing chronically ill beneficiaries with home-based primary care.

• Medical practices provide chronically ill beneficiaries with home-based primary care.

• Practices must serve 200 targeted beneficiaries living with multiple chronic diseases to be eligible– Beneficiaries must be living with multiple chronic diseases

• Incentive payments for practices successful in:– meeting quality standards; and – reducing total expenditures

• 15 independent practices and 3 consortia participating

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Comprehensive Primary Care Initiative

• Collaborating with public and private insurers in purchasing high value primary care in communities they serve.

– Requires investment across multiple payers

– individual health plans, covering only their members, cannot provide enough resources to transform primary care delivery.

• Medicare will pay approximately $20 per beneficiary per month (PBPM) then move towards smaller PBPM to be combined with shared savings opportunity.

• The 7 markets selected: Ohio (Dayton), Oklahoma (Tulsa), Arkansas, Colorado, New Jersey, Oregon, New York (Hudson Valley)

GOAL: Test a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care.

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Health Care Innovation Awards

GOAL: Funded applicants to implement the most compelling new ideas to deliver better health, improved care and lower costs to CMS beneficiaries particularly those with the highest health care needs.

Objectives: • Engage innovation partners to identify and test new care

delivery and payment models that originate in the field for identified target populations.

Identify new models of workforce development and deployment and related training and education that support new models either directly or through new infrastructure activities

• Support innovators who can rapidly deploy care improvement models (within six months of award)

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Health Care Innovation Awards

• 107 Projects Awarded - July, 2012

• Awards range from approximately $1 million to $30 million for a three-year period.

• Will impact all 50 states

• Over 3000 applications received

• from providers, payers, local government, public-private partnerships and multi-payer collaboratives.

PROGRESS:

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Health Care Innovation Awards Round Two

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GOAL: Test new innovative service delivery and payment models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.• Test models in four categories:

1. Reduce Medicare, Medicaid and/or CHIP expenditures in outpatient and/or post-acute settings

2. Improve care for populations with specialized needs

3. Transform the financial and clinical models for specific types of providers and suppliers

4. Improve the health of populations• Applications due Summer, 2013 – currently under review

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Our Ask:

• Continue the work of improving quality and patient safety

• Support the National Quality Strategy & the Partnership for Patients

• Push your organizations to support this transition to a sustainable patient center healthcare system

• Chose Your Pathways: – ACOs, Models focused on Primary Care, Bundled

Payments for Care Improvement, State Innovation Models

• Make your personal commitment to transformation

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Thank You

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innovation.cms.gov

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EllenMarie.Whelan@cms.hhs.gov