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HCI Table of Contents HCI Overview

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Triple Aim LOI

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Hospice LOI

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Housing LOI

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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

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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 Page 2 of 11


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.

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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 Page 4 of 11


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.

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Proposed Letter of Intent Name of Applicant Organization Aging Services of Michigan Brief summary of proposal (750 characters) This project builds on previous work to develop a network of premier providers to redefine and rapidly deploy programs for persons in long term supports and services settings through workforce development. The plan establishes integrated regional networks to provide cost effective access to clinicians and physician extenders, as well as standardized care pathways – while maintaining consumer choice, independence, improving wellness and reducing hospital re-admissions. Funding would assist in developing the IT infrastructure, a new 501(c) 4 entity, care management models and protocols, and programs for workforce development and training with a focus on decision-making and clinical skills. Names of Partnering Organizations Applying with Applicant Aging Services of Michigan Member Providers Health Management Associates LeadingAge Michigan Health and Hospital Association Michigan Peer Review Organization Michigan State Housing Development Authority Michigan Association of Area Agencies on Aging Michigan Home Health Association Michigan Hospice and Palliative Care Organization Omnicare Management and Network Services Dykema Gossett Applicant Organization Address 6512 Centurion Drive Lansing, MI 48917 Applicant Content Person and Address David E. Herbel 6512 Centurion Drive Lansing, MI 48917 Business Email David@AgingMI.org Proposed Target Population Description of Geographic regions where activity will occur (750 characters) The project focuses on three primary regions in the state: Southeast Michigan, Central, and West Michigan. Page 6 of 11


Principal state where proposal activity will occur Michigan List of zip codes where proposal activity will occur Primary areas will include catchment areas in and around Kent County, Southeast Michigan (Wayne, Oakland, St. Clair, Macomb, Washtenaw, Livingston, Lenawee and Monroe Counties) and Central Michigan (Saginaw, Bay, Midland, Gladwin, Clare, Gratiot, and Shiawassee). The specific zip codes are too numerous to include here. Target population age groups The primary population will include frail seniors age 55 and older Target population insurance status Seniors will be covered under Medicare, Medicaid, and other private insurers Estimated Funding request $15 million

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Proposed Letter of Intent Name of Applicant Organization Aging Services of Michigan Brief summary of proposal (750 characters) This project works to address issues about access and quality of care toward end of life, especially as related to timely admission and early intervention in providing palliative care and hospice services. The program will use defined decision-making models as the basis for consideration about when to begin important consumer and facility discussions regarding the options at end of life, and builds on work completed by the Physicians Orders for Life Sustaining Treatment projects. The expected outcomes of the project include timely access to hospice services, provider adherence to defined consumer wishes for end of life care, and improved symptom control at end of life. Names of Partnering Organizations Applying with Applicant Aging Services of Michigan Member Providers Michigan Home Health Association Michigan Hospice and Palliative Care Organization Omnicare Applicant Organization Address 6512 Centurion Drive Lansing, MI 48917 Applicant Content Person and Address David E. Herbel 6512 Centurion Drive Lansing, MI 48917 Business Email David@AgingMI.org Proposed Target Population Description of Geographic regions where activity will occur (750 characters) The project focuses on three primary regions in the state: Southeast Michigan, Central, and West Michigan. Principal state where proposal activity will occur Michigan List of zip codes where proposal activity will occur Primary areas will include catchment areas in and around Kent County, Southeast Michigan (Wayne, Oakland, St. Clair, Macomb, Washtenaw, Livingston, Lenawee and Monroe Counties) and Central Michigan (Saginaw, Bay, Midland, Gladwin, Clare, Gratiot, and Shiawassee). The specific zip codes are too numerous to include here. Page 8 of 11


Target population age groups The primary population will include frail seniors age 55 and older Target population insurance status Seniors will be covered under Medicare, Medicaid, and other private insurers Estimated Funding request $ 3 million

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Proposed Letter of Intent Name of Applicant Organization Aging Services of Michigan Brief summary of proposal (750 characters) By deploying focused skills training to the workforce our goal will be to improve quality of life, opportunities for early detection, reduced 991 calls and subsequent emergency room visits, and reduced re-admissions. This rapidly deployed project will work to integrate services and technology within affordable housing settings, to provide better access to clinical care with pharmaceutical oversight as well as ongoing remote monitoring. Program focus will be on assisting low income consumers, in urban markets to maintain independence within a wellness model. Names of Partnering Organizations Applying with Applicant Aging Services of Michigan Member Providers LeadingAge Presbyterian Villages of Michigan United Methodist Retirement Communities Applicant Organization Address 6512 Centurion Drive Lansing, MI 48917 Applicant Content Person and Address David E. Herbel 6512 Centurion Drive Lansing, MI 48917 Business Email David@AgingMI.org Proposed Target Population Description of Geographic regions where activity will occur (750 characters) The project focuses on southeast Michigan region including metropolitan Detroit and surrounding areas. Principal state where proposal activity will occur Michigan List of zip codes where proposal activity will occur Wayne Count (Detroit), as well as Oakland, Livingston, Macomb, St. Clair, Monroe, Washtenaw, and Lenawee counties. The specific zip codes are too numerous to include here. Target population age groups Page 10 of 11


The primary population will include frail seniors age 55 and older Target population insurance status Seniors will be covered under Medicare, Medicaid, and other private insurers Estimated Funding request $5 million

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