The document discusses emerging methodologies being developed by the HSCRC to incentivize population health management under a potential CMS model testing demonstration. It describes how existing methodologies like the Admission-Readmission Revenue program and Total Patient Revenue would need to be modified. New approaches under consideration include Population-Based Reimbursement and requesting authority for bundled payments, ACOs, and gain sharing. Significant effort will be required to translate these approaches to an all-payer environment in Maryland.
The CMS Innovation Center offered a kickoff webinar event for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Tuesday, May 31, 2016 from 4:00–5 p.m. EDT. This webinar focused on model objectives, terms of the award, eligibility criteria, changes from the first public solicitation and important deadlines. A 20 minute question and answer period followed the presentation.
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CMS Innovation Center
http://innovation.cms.gov
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The Primary Care First Model Options team hosted a payment webinar on Thursday, June 27, 2019 from Noon - 1:00 p.m. EDT. Topics discussed included what the Primary Care First Total Primary Care Payment and the quality measures used to calculate the Performance-Based Adjustment, beneficiary attribution, policies on overlap with other CMS models, and the timeline for receiving model payments.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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The webinar introduced the Comprehensive Primary Care initiative to the primary care provider community and covered the service delivery model, including the 5 Comprehensive Primary Care functions, and the milestones participating practices will need to achieve in the first year. The process for applying was also discussed, including information about the application itself.
More at: http://innovations.cms.gov/resources/CPCi-Webinar-for-PCPs.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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The CMS Innovation Center hosted a Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model webinar regarding the model overview and Letter of Intent (LOI) process on Thursday, January 12, 2017 from 2:00 - 3:00 p.m. EST. At this event, attendees learned more about the DDS model, eligibility criteria, and LOI requirements.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
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The CMS Innovation Center hosted a webinar on Tuesday, February 11, 2014 from 2:30 – 4:30pm EST that provided an overview of the demonstration and the application package.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center offered a kickoff webinar event for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Tuesday, May 31, 2016 from 4:00–5 p.m. EDT. This webinar focused on model objectives, terms of the award, eligibility criteria, changes from the first public solicitation and important deadlines. A 20 minute question and answer period followed the presentation.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Primary Care First Model Options team hosted a payment webinar on Thursday, June 27, 2019 from Noon - 1:00 p.m. EDT. Topics discussed included what the Primary Care First Total Primary Care Payment and the quality measures used to calculate the Performance-Based Adjustment, beneficiary attribution, policies on overlap with other CMS models, and the timeline for receiving model payments.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The webinar introduced the Comprehensive Primary Care initiative to the primary care provider community and covered the service delivery model, including the 5 Comprehensive Primary Care functions, and the milestones participating practices will need to achieve in the first year. The process for applying was also discussed, including information about the application itself.
More at: http://innovations.cms.gov/resources/CPCi-Webinar-for-PCPs.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a Beneficiary Engagement and Incentives: Direct Decision Support (DDS) Model webinar regarding the model overview and Letter of Intent (LOI) process on Thursday, January 12, 2017 from 2:00 - 3:00 p.m. EST. At this event, attendees learned more about the DDS model, eligibility criteria, and LOI requirements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a webinar on Tuesday, February 11, 2014 from 2:30 – 4:30pm EST that provided an overview of the demonstration and the application package.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Tuesday, April 9 from 2:00 p.m. - 3:00 p.m. EDT the Medicare Advantage Value-Based Insurance Design Model team provided an overview of the model’s main goals and guiding principles, provided a brief review of Medicare Advantage and the Medicare Hospice Benefit, introduced the key model design considerations, and provided a general timeline for the coming months.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The first in a series of Accountable Health Communities Model webinars was held on Thursday, January 21, 2016 from 2:00 – 3:30pm EST. The webinar focused on an overview of the model and application requirements. A repeat of the webinar covering the same topic was held Wednesday, January 27, 2016 from 3:00– 4:30pm EST.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design Model team hosted a webinar on Thursday, February 14 from 12:00 p.m. - 1:00 p.m. EST discussing the evaluation findings from the first year of the model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation hosted an Open Door Forum (ODF) to allow dialysis facilities, nephrologists, other Medicare providers of services, suppliers, and other interested parties to ask questions on the revisions to the Request for Application (RFA) for the Comprehensive End Stage Renal Disease (ESRD) Care Initiative that was released on April 15, 2014.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing letter of intent overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, March 22 from 4:00pm – 5:30pm EDT.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Emergency Triage, Treat, and Transport (ET3) Model team provided a second overview webinar of the model and timeline for release of the request for applications and notice of funding opportunity on Thursday, March 7 from 2:00 p.m. to 3:00 p.m. EST. The first in this series of webinars was held on Wednesday, February 27, 2019.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
We at Boehringer Ingelheim know that there are many issues affecting health care in the United States. In this presentation Dr. Lee Sacks of Advocate Health takes a look at accountable care organizations (ACOs) and their role in health care reform. Understanding the Implications of Accountable Care Organizations for Patients and Providers, was a web conference given on July 31, 2012 and which we hope will provide offer an understanding of best practices among ACOs and tips for helping constituents adopt and participate in ACOs.
The CMS Innovation Center hosted an informational webinar March 11, 2014 on the parameters of Models 2-4 of the Bundled Payments for Care Improvement Initiative. This webinar was geared towards physicians, specialty practices and physician group practices.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center is hosting a conference call to discuss important updates regarding the Strong Start funding opportunity. Due to numerous questions and suggestions we have received from stakeholders, CMS is revising the Funding Opportunity Announcement (FOA) to respond to the important issues stakeholders have raised. CMS will extend the application deadline to allow potential applicants the time they need to develop innovative models.
More at: http://www.innovations.cms.gov/resources/StrongStart_ConferenceCall.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
This Accountable Health Communities Model webinar was held on Wednesday, February 10, 2016 from 3:00 – 4:00pm EST. The webinar focused on the anticipated role of state Medicaid agencies in the model.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) in late 2013 entitled the “Evolution of ACO Initiatives at CMS.” These are the first of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Wednesday, April 27, 2016. During this webinar Model team members provided an overview of the model specifically for interested payers.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Tuesday, April 9 from 2:00 p.m. - 3:00 p.m. EDT the Medicare Advantage Value-Based Insurance Design Model team provided an overview of the model’s main goals and guiding principles, provided a brief review of Medicare Advantage and the Medicare Hospice Benefit, introduced the key model design considerations, and provided a general timeline for the coming months.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The first in a series of Accountable Health Communities Model webinars was held on Thursday, January 21, 2016 from 2:00 – 3:30pm EST. The webinar focused on an overview of the model and application requirements. A repeat of the webinar covering the same topic was held Wednesday, January 27, 2016 from 3:00– 4:30pm EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design Model team hosted a webinar on Thursday, February 14 from 12:00 p.m. - 1:00 p.m. EST discussing the evaluation findings from the first year of the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation hosted an Open Door Forum (ODF) to allow dialysis facilities, nephrologists, other Medicare providers of services, suppliers, and other interested parties to ask questions on the revisions to the Request for Application (RFA) for the Comprehensive End Stage Renal Disease (ESRD) Care Initiative that was released on April 15, 2014.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing letter of intent overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, March 22 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Emergency Triage, Treat, and Transport (ET3) Model team provided a second overview webinar of the model and timeline for release of the request for applications and notice of funding opportunity on Thursday, March 7 from 2:00 p.m. to 3:00 p.m. EST. The first in this series of webinars was held on Wednesday, February 27, 2019.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
We at Boehringer Ingelheim know that there are many issues affecting health care in the United States. In this presentation Dr. Lee Sacks of Advocate Health takes a look at accountable care organizations (ACOs) and their role in health care reform. Understanding the Implications of Accountable Care Organizations for Patients and Providers, was a web conference given on July 31, 2012 and which we hope will provide offer an understanding of best practices among ACOs and tips for helping constituents adopt and participate in ACOs.
The CMS Innovation Center hosted an informational webinar March 11, 2014 on the parameters of Models 2-4 of the Bundled Payments for Care Improvement Initiative. This webinar was geared towards physicians, specialty practices and physician group practices.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center is hosting a conference call to discuss important updates regarding the Strong Start funding opportunity. Due to numerous questions and suggestions we have received from stakeholders, CMS is revising the Funding Opportunity Announcement (FOA) to respond to the important issues stakeholders have raised. CMS will extend the application deadline to allow potential applicants the time they need to develop innovative models.
More at: http://www.innovations.cms.gov/resources/StrongStart_ConferenceCall.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
This Accountable Health Communities Model webinar was held on Wednesday, February 10, 2016 from 3:00 – 4:00pm EST. The webinar focused on the anticipated role of state Medicaid agencies in the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) in late 2013 entitled the “Evolution of ACO Initiatives at CMS.” These are the first of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Wednesday, April 27, 2016. During this webinar Model team members provided an overview of the model specifically for interested payers.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Health IT Summit Denver 2014 - "Anatomy of a Health System"
This unique discussion series explores behind-the-scenes looks at the most progressive and high performing health systems in the country. Panelists will discuss critical areas such as go-live strategy, vendor management, patient engagement, IT governance and more. Attendees will walk away with a better understanding of how departments can effectively work together, tangible strategies for delivering high quality care while maintaining an efficient and secure health information system.
Moderator: Cynthia Burghard, Research Director, IDC Health Insights
Marc Lassaux, CTO, Technical Director Beacon Project, Quality Health Network
Justin Aubert, Chief Financial Officer, Quality Health Network
Kevin Fitzgerald, MD, CMO, Rocky Mountain Health
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Using clinical co-management to improve quality and keep physiciansCurtis Bernstein
Reviews governmental direction for the development of clinical co-management agreements; Describes appropriate structure and development of fair market value compensation for services provided under a clinical co-management agreement.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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CMS Privacy Policy
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Evolving Approaches to Measuring the Value of New Health Technologies in the USOffice of Health Economics
At this OHE Lunchtime Seminar, Dr Steven Pearson of the ICER organisation in the US discussed current US approaches to defining "value," compared these to NICE and discussed what changes may occur in the future.
The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is an initiative designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid.
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1. Emerging HSCRC Methodologies
Mary Beth Pohl James Case
Deputy Director, Manager
Research and Methodology KPMG LLP
HSCRC
2. Population Health Incentives under a CMS
Model Testing Demonstration Alter
HSCRC Methodology Focus
• Today’s Discussion:
– Incentives under the Medicare Waiver and under a new CMS model
testing demonstration
– Emerging tools & methodologies for success under a CMS model
testing demonstration
2
3. Healthcare Challenges During Waiver
Negotiations in the 1980s
• Inpatient costs were rising rapidly across the U.S.
– Driver: Medicare and Medicaid cost-based reimbursement
• Medicare, Medicaid, and Maryland did not recognize the costs
of providing care to uninsured as a reimbursable expense.
• Hospitals serving large proportions of non-paying patients
were threatened with insolvency.
– Issues of access for patients
3
4. What Financial Policy Incentives Does
the Medicare Waiver Promote?
• Lower utilization in the inpatient
setting on a per case basis
• Equity in payment across payers
Medicare Waiver Test = – Inability to cost shift, especially from
public to private payers
Expenditures Per Discharge
• Access to care, shared cost of
social goods
• Solvency of efficient and effective
hospitals
4
5. Medicare Waiver Successes and
Limitations
Successes Limitations
• Cumulative growth rate in the • Per discharge cost is the highest in the
Maryland inpatient charge per case has nation
outperformed the nation • Outpatient expenditures not well
constrained
• Maryland has incredible hospital access • The system is volume-based leading
to care for all patient populations to potential overutilization
• Maryland has been innovative in • Difficulty in aligning with physician
system design of care related to cost financial incentives
containment, quality, etc. • Cannot engage in certain CMS
initiatives under the ACA
5
6. What Financial Policy Incentives Does a CMS
Model Testing Demonstration Promote?
• Lower inpatient and outpatient utilization
per capita
• Inpatient and outpatient cost containment
• Equity in payment across payers
Model Testing =
– Inability to cost shift, especially from public to
Expenditures Per private payers
Population • Access to care, shared cost of social goods
• Solvency of efficient and effective
hospitals
• Alignment of incentives across hospital
and professional providers
6
7. The HSCRC’s Role in Enhancing
Population Health
• CMS continues to pursue hospital reimbursement models that
shift operational mindsets to serve populations in geographic
areas with low cost, high quality care.
– Three part aim:
Better health care (enhance patient experience, improve quality)
Better health (healthy lifestyles, wider use of preventative care)
Reduce cost
• Under a model testing demonstration, HSCRC methodologies
must align with drivers to improve population health.
7
8. Model Testing Methods
• Unit rates, annual update factor, and the variable cost factor
• Reasonableness of charges
• Hospital revenue constraint
– Admission-Readmission Revenue (“ARR”)
– Total Patient Revenue (“TPR”)
– Population-based Reimbursement (“PBR”)
• New authorities
– ACOs, Gain Sharing
– Bundled Payments
• Quality
8
10. Annual Update Factor and
Volume Adjustment
• Under a model testing demonstration, HSCRC regulatory
authority will continue to rely on the annual update factor and
variable cost factor as revenue control levers.
• HSCRC will need to recast application of the annual update
factor and variable cost factor under a population-based
constraint
– Maryland must develop a robust all payer database
10
11. HSCRC Must Also Recast Reasonableness
of Charges (ROC) Methodologies
• Tools to compare hospital charges continue to serve an
important role under a model testing demonstration
• HSCRC must recast the ROC to align with a population based
constraint
• HSCRC is also investigating data sources for national
comparisons
11
12. 31 Hospitals Entered into ARR Agreements for
FY 2012
• Mercy • Anne Arundel Medical Center
• LifeBridge - Sinai • Bon Secours
• LifeBridge - Northwest • St. Joseph Medical Center
• UMMS - Baltimore Washington Medical • MedStar - Franklin Square
Center • MedStar - Good Samaritan
• UMMS - Civista Medical Center • MedStar - Harbor Hospital
• UMMS - Harford Memorial Hospital • MedStar - St. Mary's Hospital
• UMMS - Kernan Hospital • MedStar - Montgomery General Hospital
• UMMS - Maryland General Hospital • MedStar - Union Memorial Hospital
• UMMS - Upper Chesapeake Medical Center • Holy Cross Hospital
• UMMS - University of Maryland Medical • Washington Adventist Hospital
Center • Shady Grove Adventist Hospital
• JHHS - Johns Hopkins Hospital • Peninsula Regional
• JHHS - Johns Hopkins Bayview Medical • Doctors
Center • GBMC
• JHHS - Howard County General Hospital • Frederick Regional Health System
• JHHS - Suburban Hospital • Saint Agnes
12
13. ARR is a Voluntary Revenue Constraint
Program Developed by the HSCRC
• ARR provides hospitals a financial incentive to more
effectively coordinate care and reduce unnecessary
readmissions to their facilities
– Inpatient: all-cause, all-DRG, 30-day readmissions window
– Current focus on readmissions within the facility or within
the hospital system for “linked system hospitals”
• Three year program beginning in FY 2012; currently
in Year 2 of three year agreements
13
14. ARR Builds Upon the Inpatient CPC
to Develop Bundled Weights
• In weight development, HSCRC bundles CPC weights into
Charge Per Episode (CPE) weights
– For a given DRG-SOI, CPE approved revenue is higher than CPC
equivalents
• When grouping hospital discharges, HSCRC credits hospitals
with all weight associated with a 30-day episode of care
window at the initial admission
– Readmissions receive no weight
• A hospitals financially “wins” by reducing readmissions on a
case mix adjusted basis by retaining 30-day CPE weight, while
reducing the costs associated with the readmission
14
15. Using Medicare Data, Maryland has the Nation’s
Highest Readmissions Rate
25.0%
MD
21.6%
Medicare Hospital Readmission Rate 2010
US
20.0%
18.2%
15.0%
10.0%
5.0%
0.0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Source: Institute of Medicine Geographic Variation Data Base
15
17. HSCRC Must Seek Exemption from
CMS Readmissions Program in FY 2014
• ACA provides Maryland an avenue to gain exemption from CMS’
Readmissions Reduction Program
– FY 2013 IPPS final rule gives Maryland a pass on applying for the exemptions
• Next year, HSCRC anticipates needing to submit an exemption
request demonstrating how Maryland’s ARR program meets or
exceeds Medicare’s program (savings and outcomes)
• HSCRC and CMS staff discussed Maryland’s program structure
– Maryland’s program viewed as “all carrot and no stick”
– Strong indication that HSCRC must move ARR into model with explicit
Medicare savings to exemption in FFY 2014
17
18. ARR Policy Likely to Evolve
• Modification 1: Modifying ARR into a Shared Savings Model
– Preliminary options:
• Scaling approach that is not revenue neutral while setting the bar at a
threshold in line with low readmission facilities – data challenges
• Target modification –level of modification required, need modeling
• Modification 2: Readmissions Payment Methodology for All
– Hospitals not under an alternative agreement will adhere to payment
methodologies of ARR
• Modification 3: Move one-day stay cases back into CPC/CPE
– ARR “wins” held neutral for decrease in one-day stay cases
Stay Tuned…
18
19. Total Patient Revenue, a Global Budget
Arrangement, is in Place for 10 Hospitals
• Establishes a global budget for all inpatient and outpatient
hospital services for a facility
– Annually, each TPR hospital global budget inflated by the annual
update factor, plus a population adjustment (capped); no case mix
adjustment
• Best serves hospitals with defined catchment areas
• HSCRC developing TPR monitoring tools
– More timely snapshots, merging case mix and financial information
• TPR hospitals in year 3 of three year agreements
– Discussions happening for next TPR agreements
19
20. Population-Based Reimbursement (“PBR”)
• In alignment with CMS’ goals to provide incentives for
hospitals treating populations, the HSCRC has begun
exploring concepts in Population Health Management
• The methodology is still in development but it’s concepts are
as follows.
20
21. PBR Methodology – In Development
• It is important to understand the components of the PBR
concept:
– Geographic area → controls activity (cases and visits) in identified zip
codes
– Hospital spending → includes both inpatient and outpatient services
– Major services lines → responsible only for services that they provide
• Excludes tertiary services
• Excludes specialty services
21
22. PBR Methodology – In Development
Geographic Area
• The defined geographic area must be an area that the PBR
hospital controls
• Control is defined at the zip code level on a percentage basis.
Options under consideration include a range:
– 25% to 75%
• Approximately 50% of the patient activity suggests the PBR
hospital has significant market penetration to influence patient
health
– Less than 50% may not provide significant control
22
23. PBR Methodology – In Development
Hospital Spending
• The PBR encompasses the HSCRC regulated charges in the
PBR zip codes for all hospitals
– It includes both inpatient and outpatient charges
• PBR zip code thresholds could be set using an equivalent case
23
24. PBR Methodology – In Development
Major Service Lines
• PBR hospitals would only be responsible for services they provide
– For example: If the PBR hospital did not provide obstetric services,
they would be excluded from the PBR.
– Currently testing methodologies for service exclusion:
• APR-DRG basis for inpatient services
• CPT/ICD-9 basis for outpatient services
• Other exclusions could include services outside the PBR hospital’s
control. For example:
– Tertiary services (example: certain services provided JHH and UMMC)
– Specialty services (example: certain services provided at Kernan)
24
25. Methods Requiring CMS Authorization
• Under a model testing demonstration, Maryland may request
authority for methods not currently available to the state
– ACOs
– Gain sharing
– Bundled payments
• Maryland’s all payer hospital system provides power of scale to
magnify system savings under ACOs, gain sharing, and bundled
payment initiatives
– We recognize the need of these methods to enhance TPR, PBR, and ARR
– However, translating these to an all payer environment is not well defined;
will require much activity to establish the programs
25
26. Bundled Payments
• Maryland hospitals were not permitted to participate in CMS’
Bundled Payment initiative
• One of the most valuable parts of applying for the bundled
payment initiative was access to the underlying data
26
27. Bundled Payments
• How could bundled payments work in Maryland without the
participation of physicians, post-acute providers, and other
provider entities?
• Bundled payments are not a new concept
– Charge per case
– Charge per episode
– Alternative Rate Methodologies (“ARM”)
27
28. Bundled Payments
• Alternative Rate Arrangements (“ARM”)
– The Commission may permit arrangements to accept financial risk for
the provision of hospital services under certain conditions and
circumstances.
• Capitated contracts
• Global pricing
• Case-rate pricing
• Procedure-based pricing
– Must be based on underlying cost
– Must be available to all payers on the same terms and conditions
28
29. Quality
• Under a new CMS model testing demonstration hospital and
system quality continues to be important
– CMS will require monitoring across a range of indicators including access
to care and patient experience
– CMS also will require reporting
• Continue to move forward initiatives to keep pace with CMS
quality programs
29
30. In Conclusion…
• The State is working with CMS to develop a CMS model
testing demonstration with incentives around population health
management.
• The HSCRC’s tools and methodologies must support the shift
in this operational mindset.
• It will take significant efforts from HSCRC and hospital staff
to develop thoughtful methods to succeed under this new
model testing approach.
30
31. Emerging HSCRC Methodologies
Mary Beth Pohl James Case
Deputy Director, Manager
Research and Methodology KPMG LLP
HSCRC
Mary.Pohl@maryland.gov jcase@kpmg.com