The Centers for Medicare and Medicaid Innovation, while enhancing innovative practices in effective healthcare delivery, facilitates the growth of Accountable Care Organizations (ACOS).Through technological models like electronic health records, not only is service delivery empowered in terms of access to patient data, but the system also offers much more benefits to the patients.
The Centers for Medicare and Medicaid Innovation is a body that is charged with the role of developing service delivery and payment models, implementing the Quality Payment Program and integrating clinicians of various capacities in the development and implementation of the models (Nash, Reifsnyder, Fabius, & Pracilio, 2010). Among the models is the Accountable Care Organizations (ACOs), based on the Affordable Care Act (ACA), which encourages providers to focus on populations and offer quality and efficient health care services (Nickitas et al., 2016). The four initiatives under ACOs include Pioneer ACO model, ACO investment model, Advance Payment ACO model, and the Comprehensive End-Stage Renal Disease Care Initiative. Technology has been used as well in order to foster health outcomes in patients. An example is the Electronic Health Records (EHR) in which the caregiver is able to make records about the patient’s health. EHRs make it possible for patients to receive optimum care since all their medical information can be easily accessed by their health care providers. Moreover, patients can be reminded of their preventive visits and any other schedules with their physicians and thus prevent further disastrous situations (Nash, et al., 2010).
The Centers for Medicare and Medicaid Services (CMS) uses quality measures in order to quantify goals, systems, and processes like safe, timely, patient-centered, and effective care. Data is collected by various methods, including registries and assessment instruments. The Electronic Health Records (EHR) are one way in which quality measures data is collected (Nickitas et al., 2016). The National Quality Forum measure that can be used for patients with Schizophrenia, for instance, deals with the process. The measure, NQF 1879, targets adults and elderly patients with schizophrenia with “at least two prescription drug claims for antipsychotic medications…” (Centers for Medicare & Medicaid Services, 2017). Antipsychotic drugs have been found to be effective in treating schizophrenic patients.
Nash et al. also propose that an EHR should give the patients details such as their problems, diagnoses, and allergies, among others so that they can facilitate clinical decision support for the patient (2010).
Centers for Medicare & Medicaid Services (CMS). ( 2017). Quality Measures. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html
Nash, D. B., Reifsnyder, J., Fabius, R. J., & Pracilio, V. P. (2010). Population Health: Creating a Culture of Wellness. Jones & Bartlett Learning.
Nickitas, D., Middaugh, D. J., & Aries, N. (2016). Policy and Politics for Nurses and Other Health Professionals: Advocacy and Action (2nd Ed.). Jones & Bartlett Learning.
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The Innovation Center allows the Medicare and Medicaid programs to test models that improve care, lower costs, and better align payment systems to support patient-centered practices. The Innovation Center carefully evaluates innovative reform efforts widely used in the private sector, and is unique in its ability to develop provider-proposed approaches and quickly adjust models in response to feedback from clinicians and patients.
The Innovation Center was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). Congress created the Innovation Center for the purpose of testing “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.
Congress provided the Secretary of Health and Human Services (HHS) with the authority to expand the scope and duration of a model being tested through rulemaking, including the option of testing on a nationwide basis. In order for the Secretary to exercise this authority, a model must either reduce spending without reducing the quality of care, or improve the quality of care without increasing spending, and must not deny or limit the coverage or provision of any benefits. These determinations are made based on evaluations performed by the Centers for Medicare & Medicaid Services (CMS) and the certification of CMS’s Chief Actuary with respect to spending.
The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation a number of specific demonstrations to be conducted by CMS.
The Innovation Center also plays a critical role in implementing the Quality Payment Program, which Congress created as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace Medicare’s Sustainable Growth Rate formula to pay for physicians’ and other providers’ services. In this new program, clinicians may earn incentive payments by participating to a sufficient extent in Advanced Alternative Payment Models (APMs). In Advanced APMs clinicians accept some risk for their patients’ quality and cost outcomes and meet other specified criteria.
The Innovation Center is working in consultation with clinicians to increase the number and variety of models available to ensure that a wide range of clinicians, including those in small practices and rural areas, have the option to participate.
The Innovation Center conducts an evaluation of each new payment and service delivery model tested. Statute specifies that measures in each evaluation must include an analysis of the quality of care furnished under the model (including the measurement of patient-level outcomes and patient-centeredness criteria) as well as changes in spending.
In addition to the rigorous evaluation of the impact of each model on outcomes of interest, the Innovation Center provides frequent feedback to providers who participate in each model in order to support continuous quality improvement, with the understanding that learning and adaptation are essential to enable providers and health systems to achieve the greatest efficiencies and improvements possible in each new payment model. The Innovation Center leverages claims data to deliver actionable feedback to providers about their performance, and encourages participating providers to use their own performance data to drive continuous improvement in their outcomes.
Every test of a new service delivery or payment model developed by the Innovation Center also includes a plan of action to ensure that the lessons learned and best practices identified during the test can be spread as widely and effectively as possible to support improvement for both CMS and the health care system at large. Evaluation results are shared with participating providers on an ongoing basis in order to promote more rapid learning. The Innovation Center has also created learning collaboratives for providers in our models to promote broad and rapid dissemination of evidence and best practices that have the potential to deliver higher quality and lower cost care for Medicare, Medicaid and CHIP beneficiaries.
B. Biles, G. Casillas, G. Arnold, and S. Guterman, The Impact of Health Reform on the Medicare Advantage Program: Realigning Payment with Performance (New York: The Commonwealth Fund, Oct. 2012).
Centers for Medicare and Medicaid Services, “Medicare Advantage Enrollment at All-Time High; Premiums Remain Affordable,” press release, Sept. 18, 2014, http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-18.html.