Center for Medicare and Medicaid Innovation Health Care Innovation Challenge 1115 Waiver Opportunities Overview Letter of Intent due December 19 Electronic Application due January 27 Period: March 30, 2012 through March 29, 2015 Purpose Delivering the 3 part aim – better health, better health care and lower cost through improved quality Test alternative models for care delivery and payment Facilitate learning and diffusing of best practices Promote the development of a workforce capable of supporting care transformation Successful models will: Rapidly develop or deploy requisite workforce to support the proposed model Show capability to improve care within the first six months of the award Create a sustainable pathway to net Medicare/Medicaid savings within 2-3 years Improve coordination, efficiency, and quality Many populations including the frail elderly often face obstacles when accessing health services or working towards a healthier life style. Traditional visit based, in-office services often do not effectively meet their needs, contributing to poor health outcomes and an increasing trend in cost of care for these patients. Current innovative programs in urban and regional areas could be expanded to broader populations across the country. Improvement networks work cooperatively on strategies. One factor limiting diffusion of ideas has been the shortage of an appropriately trained workforce. Staff needs to be trained in prevention, care coordination, care process re-engineering, dissemination of best practices, team based care, continuous quality improvement, and the use of data to support a transformed system. Training and educational experiences will be needed to help develop this knowledge and these skills. Such systems also require new knowledge transfer and information technology infrastructure. Electronic health records are central to this effort and are being
supported through several national initiatives. Learning health systems can deliver better outcomes. The Health Care Innovation Challenge will fund applicants who propose the most compelling new service delivery and payment models that will drive system transformation and deliver better outcomes. Not intended to be prescriptive, but an open invitation to: Engage a broad set of innovation partners to identify and test new care delivery and payment models that originate in the field and that produce better care, better health, and reduced cost through improvement for identified 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 through new ventures or expansion, in conjunction with public and private sector partners. Proposals Should focus on high risk groups, such as persons with multiple chronic conditions and frail elderly. Describe the services to be delivered and how payment would be constructed around the delivery model. How payment approach tested related to benefit designs that CMS can consider for broader application. Introduce tests of scalability for models known to achieve three part aim outcomes. New payment approaches should focus on models that do not simply expand fee for service payments Current payment policies do not support workforce needs. Many coordination models utilize less expensive but potentially highly effective individuals who are trained to interact with patients in a focused way to address preventive health and chronic conditions. Use of personal and home care aides to help the elderly age at home Expanding use of paramedics to extend available primary care resources in rural communities Use of community based nurse teams working with primary care practices to provide intensive care management for complex patients Infrastructure support could test broad implementation of registries, data intermediaries for quality reporting and information sharing to support coordination of care, community based care coordinating systems, innovation or improvement networks or community collaborative. Partners can include: clinicians, health systems, private and public payers, community colleges/vocations schools, community and faith based organizations, local
governments. Applicants should have a track record of success in identifying and caring for these populations. And should be able to quickly expand or actualize a well developed model Preference will be given to those proposals that create capacity and demonstrate workforce impact and potential for replication and scale. Speed to implementation: Proposed models should already be operational in related contexts or sufficiently developed to be rapidly deployed. Proposals will be expected to complete the infrastructure and capacity related activities within six months of the award. Preference will be given to projects that implement care improvements in less than six months. Training programs are eligible but should be intensive, brief programs connected to the model being tested. Sustainability Define and test a clear pathway to sustainability. Funding will support initial start up and support over a limited time period. Descriptions of expected positive impact on the three part aim must be included along with a proposed sustained business model. Sustain activity beyond the three years of the program, describing the anticipated source of ongoing support. Changes in federal funding and innovative payment approaches may be proposed as the mechanism for sustainability, identifying both the source of payment and anticipated pricing of the service. Demonstrate the ability of the program to inform future payment approaches for CMS consideration and recommendations for the scaling and diffusion of the proposed model. Sustainability can include: public/private partnerships; multi-payer approaches; new direct payment models for innovative care delivery or service; shared savings opportunities with CMS or other payers; and or proposed agreements with ACOs or advanced primary care models. Evaluation and Monitoring Clearly include quantifiable means for evaluating the impact of the program on the three part aim Each applicant must monitor, evaluate, and report on progress and impact CMS contractors will also conduct an independent evaluation Each applicant will provide quality indicators with a continuous improvement method of measurement to be used to evaluate impact. The following domains should be included: patient satisfaction and or patient experience; utilization, clinical quality, patient access. Measures should be collected and analyzed on an ongoing basis, and enabled where possible with health IT such as certified electronic health records, registries data, and electronic reporting mechanisms.
CMS will make more information on standard measures available at www.innovations.cms.gov Each applicant will be measured on their ability to achieve better health and demonstrate improvements in how their strategies will contribute to improving the health of the targeted population. Impact on lower costs – each model is expected to generate savings for the total cost of care for the beneficiary population its program affects. Must complete budget form SF 424A and a financial plan demonstrating the ability to achieve savings over the three year term of the award and on an annualized basis after project is completed. Also need detailed back up financial models explaining the logic driving their forecast cost of care savings (that is increased care coordination expenses of x will drive reductions in ER visits representing Y). Successful applicants will demonstrate the ability to achieve satisfactory improvement in cost of care along the following dimensions – Program level net savings over the duration of each award and Projected medical cost trend reduction that results from building the sustainable new model continuing after the cooperative agreement period is complete Operational Performance Awardees will be measured on their ability to execute their proposed operational work plan. The components of the work plan include but are not limited to: Meeting proposed milestones and deliverables Producing timely and accurate reports with clear progress on quality and cost performance as described above Acquiring, training, and deploying workforce Building and/or enhancing required infrastructure Awardees will be expected to report actual performance compared to forecast on cost and quality measures and operational performance, and CMS will regularly monitor the results. CMS will also collect a standard minimum set of performance indicators through its monitoring and evaluation contractors. Learning and Diffusion Awardees will be required to participate in CMS sponsored learning sessions about how care delivery orgs can achieve performance improvements quickly and effectively. CMS will look for convergence among awardees and create learning networks to share practices. Restrictions on awards Award dollars cannot be used for specific components that are not integrated into the entire service delivery and payment model proposed. Proposals cannot replicate models
being currently tested in other initiatives. CMS may work with awardees to align and group proposed models with some shared characteristics. Range of awards $1 -30 million Awards will be made through cooperative agreements. Review and selection Recommendations of the review panel based on Geographic diversity of awardees Range of service delivery and payment models proposed Reviews for programmatic and grants management compliance Reasonableness of estimated cost and anticipated results CMS intends to fund projects in communities with a wide variety of geographic and socio-economic characteristics, including underserved urban and rural areas.
Health Care Innovation Challenge - Project Overview Identify small committed workgroup including roles and responsibilities Review project requirements along with risks and benefits Review all materials issued to date Develop a list of questions and issues to address with CMS Develop Conceptual Model Identify opportunities for shared services and operations based on CMS project guideline Identify proposed participants and evaluate current state of development for Care transitions Clinical coverage models Staff training and expertise Electronic medical record systems Evidence based care development for a set of clinical conditions to identify and implement EBC rapidly Supporting shared service efficiencies Identify proposed participants current relationships and outcomes Identify relationship for improved care coordination and long term care provision Document and develop a logic model that shows potential efficiencies and supporting rationale Identify individual provider best practices and opportunities for sharing/implementing regionally Develop proposed structure for statewide steering committee to guide regional networks Determine an organizational structure that provides oversight to potential regional network entities Determine regional network entity organization and legal issues/ramifications Identify communication plan for the network Develop shared services plan Establish the model for statewide and regional network management Finalize model based on agreed services, efficiencies, and proposed outcomes Finalize list of member participants Determine resource needs for proposed model Review system challenges and current Michigan projects to address barriers Complete project application and narrative Bundled payment model development Identify small committed workgroup including roles and responsibilities Review project requirements along with risks and benefits Review CMS demonstration projects - issues and outcomes Review all materials issued to date Develop a list of questions and issues to address with CMS General Lit review on rehospitalizations and fragmented care
11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 12/5/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/28/2011 12/28/2011 12/28/2011 1/13/2012 1/13/2012 1/13/2012 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011 11/29/2011
12/5/2011 12/5/2011 12/5/2011 12/5/2011 12/5/2011 1/13/2012 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/9/2011 12/21/2011 12/21/2011 12/21/2011 12/21/2011 12/21/2011 12/21/2011 12/21/2011 12/21/2011 12/21/2011 1/13/2012 1/13/2012 1/13/2012 1/20/2012 1/20/2012 1/20/2012 12/16/2011 12/16/2011 12/16/2011 12/16/2011 12/16/2011 12/16/2011 12/16/2011
Send a letter to included providers in LOI Identify current provider relationships especially with hospitals and physicians for proposed conditions Review available outcome data for the particpating providers and determine opportunities Review cost and pricing issues for individual participating providers Identify regional ability to incur risk and demonstrate risk taking ability to CMS Determine opportunities to work with State entities - Medicaid, etc and develop communications plan Develop specific project activities designed to foster efficiencies and outcomes Continuously re-engineering/rapid cycle improvement processes Creation of a learning network Develop care coordination model that includes resources and plans for access to clinical oversight Develop parameters for bundled payment project Review 18 sample episode definitions and data analysis Review CMS data provided Review model for regional networks and identify need for additional data Determine the episode of care based on previous analysis Consider dual eligible models with lengthened PA periods and Medicaid involvement Determine conditions most likely to provide savings opportunities and outcome improvement Determine what evidence based models apply to selected conditions and how they can be implemented Determine how many beneficiaries can effectively be reached and potential Medicare/ provider savings Determine pricing plans Determine opportunities based on CMS data and any additional data used Determine entities to be included Develop a communications/engagement plan for potential providers and consumers Determine quality assurance monitoring plan Determine CMS minimum reporting expectations Develop learning network structure Rapid cycle improvements based on evidence based practices Develop overall QI plan Develop the application Confirm and document the final proposed model Develop the workplan Complete application
12/19/2011 1/3/2012 1/3/2012 1/3/2012 1/27/2012 12/1/2011 12/1/2011 12/1/2011 12/1/2011 12/1/2011 12/1/2011 12/1/2011 12/14/2011 12/14/2011 1/18/2012 1/18/2012 1/18/2012 1/3/2012 1/3/2012 1/18/2012 1/18/2012 1/18/2012 1/18/2012 1/3/2012 12/1/2011 12/1/2011 12/1/2011 1/2/2012 2/22/2012 2/1/2012 2/1/2012 2/1/2012
12/21/2011 1/19/2012 1/27/2012 1/27/2012 2/9/2012 2/9/2012 2/9/2012 2/9/2012 2/9/2012 2/9/2012 2/22/2012 12/21/2011 1/18/2012 1/3/2012 2/8/2012 2/8/2012 2/14/2012 2/22/2012 2/22/2012 2/7/2012 2/1/2012 2/7/2012 2/7/2012 2/15/2012 1/3/2012 1/3/2012 1/3/2012 1/31/2012 3/1/2012 3/1/2012 3/1/2012 3/1/2012