Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (11)
Similar to Health care innovation award overview
Similar to Health care innovation award overview (20)
Recently uploaded
Recently uploaded (20)
Health care innovation award overview
- 2. HCIA Background • The Innovation Center was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). • Housed within the Centers for Medicare and Medicaid Services (CMS) • Administers the HCIA ©2013 PrimePoint, LLC. All Rights Reserved. 2 http://innovation.cms.gov
- 3. HCIA Background • Designed to: – Test innovative health care payment and service delivery models – Lower Medicare, Medicaid, and CHIP spending – Maintaining or improving the quality of beneficiaries’ care ©2013 PrimePoint, LLC. All Rights Reserved. 3 HCIA is focused on new ways of doing business that improves access to healthcare, improves quality of health care, and lowers health care costs.
- 4. Round One • First round awards announced in May 2012 • Awards made to 107 applicants • Awards range from approximately $1 million to $26.5 million • Highly competitive ©2013 PrimePoint, LLC. All Rights Reserved. 4 Less than 5% of applications were funded in Round One • 700 did not meet initial review criteria • 2,260 met review criteria
- 5. Round One Award Winner • Vanderbilt University • Award Amount: $18,846,090 • Estimated 3-Year Savings: $27,269,705 • Project Summary: Improve ambulatory chronic disease management for high-risk, high cost patients with hypertension, congestive heart failure, and diabetes, many of them beneficiaries of Medicare and Medicaid, in 18 rural and urban counties in Tennessee and Kentucky. ©2013 PrimePoint, LLC. All Rights Reserved. 5
- 6. Round One Award Winner • Finger Lakes Health Systems Agency • Award Amount: $26,583,892 • Estimated 3-Year Savings: $48,021,083 • Project Summary: Community-wide outcomes-based payment model for primary care that will serve Medicare and Medicaid beneficiaries in six counties in the Rochester, New York area. The project creates a collaborative of providers, payers, employers, government, patients, s ocial coalitions, and community service organizations to integrate community services with primary care and leverage social and health care resources. ©2013 PrimePoint, LLC. All Rights Reserved. 6
- 7. Round One Award Winner • Intermountain Healthcare • Award Amount: $9,724,142 • Estimated 3-Year Savings: $67,120,215 • Project Summary: Intermountain Healthcare, with 23 hospitals and 185 clinics in Utah and Southern Idaho, will test a new care delivery and payment model using an information technology-based simulation of human physiology, clinical events, and health care systems to forecast which interventions will be most effective in reducing a person’s risk, provide risk stratification metrics for individual patients, and project benefits for specific interventions. ©2013 PrimePoint, LLC. All Rights Reserved. 7
- 8. Round Two Overview • Up to $900 million is available for new awards • Will fund applicants who propose new payment and service delivery models that have the greatest likelihood of driving health care system transformation • Focus on better outcomes for Medicare, Medicaid, and CHIP beneficiaries • No cost sharing or matching requirement©2013 PrimePoint, LLC. All Rights Reserved. 8
- 9. Eligible Applicants • Provider groups, health systems, payers and other private sector organizations, faith-based organizations, state and/or local governments, academic institutions, research organizations, public- private partnerships, and for-profit organizations • Technology developers, including software designers and others creating solutions for health care providers, may apply ©2013 PrimePoint, LLC. All Rights Reserved. 9
- 10. Four Innovation Categories • Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings • Models that improve care for populations with specialized needs • Models that test approaches for specific types of providers to transform their financial and clinical models • Models that improve the health of populations – defined geographically, clinically, or by socioeconomic class ©2013 PrimePoint, LLC. All Rights Reserved. 10
- 11. Initiative Requirements - Model • Must demonstrated how payment and service delivery models being tested related to benefit designs and/or new payment approaches that CMS can consider for broader application • Must explain how the proposed model will result in improved patient care and ensure protection of beneficiary access to care ©2013 PrimePoint, LLC. All Rights Reserved. 11
- 12. Initiative Requirements - Model ©2013 PrimePoint, LLC. All Rights Reserved. 12 Scalability of Proven Interventions • Models known to improve quality and reduce costs New Alternative Approaches • Not simply expanding or supplementing fee-for- service payments
- 13. Inclusion of Payers • Include feasible approach for securing participation of multiple payers • Preference will be give to applications that include participation of non-CMS payers at the outset of the model’s implementation ©2013 PrimePoint, LLC. All Rights Reserved. 13
- 14. Data Analytics and Technology • Testing the implementation of analytical tools to coordinate and improve care • Improving transparency • Health information exchanges • Telemedicine and remote monitoring • Clinical registry systems • Medication reconciliation systems • Decision support and shared decision-making systems ©2013 PrimePoint, LLC. All Rights Reserved. 14
- 15. Speed to Implementation • Rapid implementation • Infrastructure and capacity-related activities must be completed within six months of award • Preference will be given to models that implement their care improvement activities faster than six months ©2013 PrimePoint, LLC. All Rights Reserved. 15
- 16. Payment Model Design • Must be consistent with the new service delivery model funded through this competition • Must result in savings for Medicare, Medicaid and/or CHIP • Must be sustainable ©2013 PrimePoint, LLC. All Rights Reserved. 16
- 17. Payment Model Design • The model must include: – Medicare, Medicaid, and/or CHIP, though ideally it should include other payers as well – A description of how funds will flow under the model – A description of the specific provider or beneficiary incentives the payment model would create – A description of the risk parameters – A description of how the payment model would deliver a return on investment for CMS – A description of how the parameters of the payment model would progress over time ©2013 PrimePoint, LLC. All Rights Reserved. 17
- 18. Examples of Payment Models • New Medicare, Medicaid, and/or CHIP payment models supporting innovative care service delivery models with commitment from other payers • Models that share savings (and risk) with providers • Tiered value-based payment schedules that pay more for services with a strong evidence base for their effectiveness and less for services that are not as effective as alternatives • Hybrid models that blend unit-based and per-case payment • Other innovative forms of payment for specific types of services designed to reduce barriers to use of most appropriate forms of care and to reward efficient providers of high-quality, evidence-based services ©2013 PrimePoint, LLC. All Rights Reserved. 18
- 19. Financial Plan • A financial plan must be submitted with the application – Must estimate ROI for Medicare, Medicaid, and/or CHIP • If requesting less than $10 million in funding, the financial plan must be reviewed and certified by the applicant’s CFO (cannot be the ED). The applicants are also encouraged to submit, but not required, and actuarial review of their financial plan. • Applicants requesting $10 million or more in funding are required to submit an external actuarial certification of their financial plan with the application ©2013 PrimePoint, LLC. All Rights Reserved. 19
- 20. Evaluation • Improved Care • Improved Health Outcomes • Reduced Costs ©2013 PrimePoint, LLC. All Rights Reserved. 20 ‐ Patient satisfaction ‐ Adhering to evidence-based practices and reducing inappropriate utilization ‐ Clinical quality ‐ Patient access ‐ Patient outcomes ‐ Net savings to Medicare, Medicaid and/or CHIP ‐ Medical cost trend reduction that results from building a sustainable new payment model that continues after the agreement period
- 21. Evaluation • CMS will also collect from awardees a standard minimum set of performance indicators through CMS monitoring and evaluation contractors • Contractors will assist in monitoring the models and conducting independent evaluations ©2013 PrimePoint, LLC. All Rights Reserved. 21
- 22. Restrictions • CMS will not fund models that focus primarily on acute hospital inpatient care • Cannot use award dollars to make improvements to property not owned by the federal government; minor alterations and renovations may sometimes be allowed • CMS will not fund proposals that duplicate models being tested in other initiatives or other proposals being investigate elsewhere in HHS • Will not fund provision of services to non-CMS beneficiaries • Will not fund applicants that cannot monitor, self- evaluate, and report on progress in a timely manner ©2013 PrimePoint, LLC. All Rights Reserved. 22
- 23. Restrictions • Funds cannot be used to reimburse se pre-award costs • Funds cannot be used to match any other federal funds • Funds may not supplant existing federal, state, local or private funding of infrastructure or services, such as staff or salaries • Funds cannot be used by local entities to satisfy state matching requirements • Funds may not be used to engage in lobbying activities of any kind ©2013 PrimePoint, LLC. All Rights Reserved. 23
- 24. Application Outline • SECTION 1 – DESIGN (25 points) – Model Goals and Targeting – Comprehensive Description of the Model and Supporting Evidence Base – Participant Recruitment and Enrollment – Education and Outreach – Community Integration – Targeting Medicaid and CHIP Populations – Multipayer Engagement ©2013 PrimePoint, LLC. All Rights Reserved. 24
- 25. Application Outline • SECTION 2 – ORGANIZATIONAL CAPACITY (25 points) – Organization and Administration • Experience / track record of performance • Understanding community needs / target population • Tasks to be conducted by each administrative component • Financial strength and stability • Ability to fully implement payment model ©2013 PrimePoint, LLC. All Rights Reserved. 25
- 26. Application Outline • SECTION 3 – ROI (20 points) – Reduce medical cost trend for the identified population – Reduce net programmatic expenditure for CMS • Financial Plan • Model Sustainability Plan • Actuarial Review ©2013 PrimePoint, LLC. All Rights Reserved. 26
- 27. Application Outline • SECTION 4 – MONITORING, REPORTING AND EVALUATION (10 points) – Collecting and producing data and analysis – Self-monitoring plan – Use of validated tools to measure patient experience of care and satisfaction – Facilitate evaluation contractor work ©2013 PrimePoint, LLC. All Rights Reserved. 27
- 28. Application Outline • SECTION 5 – FUNDING AND SUSTAINABILITY – Budget Form SF424A and Budget Narrative – Cost breakdowns and descriptions – Org chart for entity managing the cooperative agreement – Narrative staffing plan ©2013 PrimePoint, LLC. All Rights Reserved. 28
- 29. Application Outline • SECTION 6 – SUPPLEMENTARY MATERIALS – Operational Plan – Executive Overview ©2013 PrimePoint, LLC. All Rights Reserved. 29
- 30. Award Information • Approximately 100 awards will be made • Range of awards is $1 million to $30 million • The period of performance is 3 years; the budget period is 12 months ©2013 PrimePoint, LLC. All Rights Reserved. 30
- 31. First Steps to Apply • Register in the System for Award Management (SAM) – Must have your DUNS and EIN/TIN numbers in order to register • The Authorized Organizational Representative (AOR) must register with Grants.gov for a username and password • Register EARLY! • Download application materials at Grants.gov ©2013 PrimePoint, LLC. All Rights Reserved. 31
- 32. Key Dates ©2013 PrimePoint, LLC. All Rights Reserved. 32 June 28, 2013 August 15, 2013 January 2014 Letter of Intent Due Date Application Due Date Anticipated Awardee Announcement
- 33. Help with HCIA Proposal • PrimePoint Grant Funding Intelligence ToolTM (Grant-FitTM) • Addresses core criteria found in most grant proposals including the HCIA • Makes sure that you have the resources, personnel, strate gy, and models in place to link to funding opportunities ©2013 PrimePoint, LLC. All Rights Reserved. 33 Grant- FitTM Leadership Relationships ProgramsOperations Resources
- 34. Help with HCIA Proposal • PrimePoint experts have decades of experience as grant writers, grant administrators and peer reviewers • Comprehensive grant writing services • Connection to health care industry and evaluation experts as needed • If including technology for telemedicine, connecting you to other entities that can help cover grant writing fees ©2013 PrimePoint, LLC. All Rights Reserved. 34
- 35. Contact Us PrimePoint Grant Writing Assistance Email: grants@primepoint.org Phone: 606-802-2949 ©2013 PrimePoint, LLC. All Rights Reserved. 35
Editor's Notes
- Hello, and welcome to the PrimePoint Grant Series Webinar. This webinar will feature an overview of the recently announced Health Care Innovation Awards competition, examples of previous award-winning projects, and information on how you can get help with your application.My name is Elizabeth Burton, CEO of PrimePoint. I’m glad you could join us today to learn about this exciting opportunity for your healthcare organization. Now, sit back, relax, and let’s get started!
- The Innovation Center is housed within the Centers for Medicare and Medicaid Services, and was established by an addition to the Social Security Act through the Affordable Care Act. The Health Care Innovation Award competition is administered through the Innovation Center at CMS.The Innovation Center is currently focused on three broad priorities:Testing new payment and service delivery modelsEvaluating results and advancing best practicesEngaging a broad range of stakeholders to develop additional models for testingFor more information, visit innovation.cms.gov. There, you can find information on the Innovation Center, focus areas for funding, previous award winners, and upcoming initiatives.
- The Affordable Care Act authorized the Centers for Medicare and Medicaid Innovation to test innovative health care payment and service delivery models that have the potential to lower Medicare, Medicaid, and CHIP spending while maintaining or improving the quality of beneficiaries’ care.
- Award winners from 2012 include models that enhance primary care, coordinate care across multiple settings, deploy new types of healthcare workers, help patients and providers make better decisions, and test new service delivery technologies.Let’s take a look at some of the previous award winners, to give you a better idea of the types of projects funded by CMS through the Health Care Innovation Awards.
- Now that you have a sense of what was funded in Round One, let’s talk about Round Two.
- Service delivery model refers to the manner in which providers organize and deliver care to patients. Payment model refers to the manner in which Medicare, Medicaid, or CHIP pay providers in order to incentivize them to provide efficient, high quality care.
- Certain organizations may apply as conveners that assemble and coordinate the efforts of a group of participants.Unsuccessful applicants from prior CMS funding competitions are eligible to apply.Technology developers – any such technology model needs to reflect the actual use, not the development of, a product in a broader service delivery or payment model. Applicants that develop open source technology or software that are placed in the public domain will be given preference in this competition.
- The first round was a broad solicitation in which CMS welcomed a variety of types of proposals. In this round, CMS is specifically seeking new payment and service delivery models in four broad Innovation categories.Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings. Priority areas are diagnostic services, outpatient radiology, high-cost physician-administered drugs, home based services, therapeutic services, and post-acute services. Preference will be given to submissions within these priority areas, however, CMS will consider submissions in other outpatient or post-acute areas within this category.Models that improve care for populations with specialized needs. Priority areas are high-cost pediatric populations, children in foster care, children at high risk for dental disease, adolescents in crisis, persons with Alzheimer’s disease, persons living with HIV/AIDS, persons requiring long-term support and services, and persons with serious behavioral health needs.Models that test approaches for specific types of providers to transform their financial and clinical models. Priority areas are models designed for physician specialties and subspecialties (such as oncology and cardiology), and for pediatric providers who provide services to children with complex medical issues (multiple medical conditions, behavioral health issues, congenital disease, chronic respiratory disease, and complex social issues; and that include, as appropriate, shared decision-making mechanisms to engage beneficiaries and their families and/or caregivers in treatment choices.Models that improve the health of populations – defined geographically, clinically, or by socioeconomic class – through prevention activities (diabetes prevention program, hypertension prevention program), and through wellness and comprehensive care that extend beyond the clinical service delivery area. These models must have a direct link to improving the quality and reducing the costs of care for Medicare, Medicaid and/or CHIP beneficiaries. Priority areas are models that lead to better prevention and control of cardiovascular disease, hypertension, diabetes, chronic obstructive pulmonary disease, asthma, and HIV/AIDS; models that promote behaviors that reduce risk for chronic disease, including increased physical activity and improved nutrition; models that promote medication adherence and self-management skills; models that prevent falls among older adults; and broader models that link clinical care with community-based interventions.
- Now, let’s discuss some of the requirements of the models proposed for HCIA funding.
- CMS is also interested in projects that are scalable. Applicants may propose tests of scalability for models known to improve quality and reduce costs, that is, models to spread proven interventions to different or broader Medicare, Medicaid, and/or CHIP populations.CMS also prefers models that propose new, alternative approaches, rather than simply expanding or supplementing fee-for-service payments. New, alternative models will receive priority during the review process.
- As part of the application process, applicants must include the participation of multiple payers and provide evidence of their participation. Applications should include demonstrable commitments from current payer partners, current contracts, letters of support or commitment from private insurers, state governments or local governments.Preference will also be given to applications that include participation of non-CMS payers at the outset of the model’s implementation.
- CMS recognizes that new types of data analytics and other technological approaches may be important to achieving optimal efficiency and improved outcomes in healthcare delivery. Models that use data analytics to improve care could include, but are not limited to:Models that test the implementation of analytical tools to coordinate and improve careModels that improve transparencyModels that use Health Information ExchangesModels that use Telemedicine and Remote monitoringModels that use Clinical registry systemsModels that use Medical reconciliation systems; andDecision support and shared decision-making systems
- Proposed models should be capable of rapid implementation. Awardees will be expected to complete the infrastructure and capacity-related activities within six months of the award, and start improving care as rapidly as possible.Preference will be give to models that can implement care improvement activities faster than six months.Organizations that already have a plan in place, have resources aligned, and staff trained will have a competitive edge in this competition.
- Should be designed to provide a sustainable source of funding for the delivery model after the cooperative agreement period as ended
- Applicants have the option to submit, as part of their application, a detailed and fully developed payment model, as well as a list of payers interested in testing the new payment and service deliver model.If they have not already done so as part of the application submitted, awardees must deliver, during or by the conclusion of the cooperative agreement period, a detailed and fully developed version of the payment model required above, as well as a list of payers interested in testing the payment and service delivery model.
- Each applicant will propose quality indicators with a continuous improvement method of measurement to be used to evaluate the impact of the proposed model on better care and better health.Each applicant will demonstrate the ability to achieve satisfactory improvement in cost of care, while ensuring protection of care quality and access for beneficiaries.Measures should be enabled, where possible, by health IT such as certified electronic health records, registries, data analytics, and other electronic reporting mechanisms. CMS will make more information on standard measures available at http://innovation.cms.gov.
- Applicants are encouraged to register early so that they have sufficient time to complete the registration, and it does not impair your ability to meet required submission deadlines.All applicants must have a Dun and Bradstreet Data Universal Numbering System number. If you do not have a DUNS number, go to www.dunandbradstreet.com or call 1-866-705-5711. The AOR is the person who will officially submit and application on behalf of your organization. AORs must wait one business day after registration in SAM before entering their profiles in Grants.gov.The most common reasons that applications are not accepted by Grants.gov are:SAM registration cannot be located or validatedSAM registration has expiredThe AOR is not authorized by the E-Biz POC to submit and application on behalf of the organizationFile attachments do not comply with Grants.gov file attachment requirements
- Applicants MUST submit non-binding Letters of Intent to Apply. LIAs provide information to CMS in determining the expertise and personnel necessary to review applications and issue awards. LIAs must be received by 3:00 p.m. EASTERN time on June 28, 2013. Failure to submit an LIA will disqualify the application from the organization and it will not be reviewed. The LIA is provided through an online form. Instructions are posted on the Innovation Center’s website at http://innovation.cms.gov