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.
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays.
In this webinar, staff from the Medicare-Medicaid Coordination Office (MMCO) and the CMS Innovation Center will provide an overview of the initiative, and offer information about how to apply.
More at: http://innovations.cms.gov/resources/Duals_rahnfr_apply.html
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The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
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http://innovation.cms.gov
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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
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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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http://innovation.cms.gov
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The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model final rule on Wednesday, February 22, 2017, from 12:00 p.m. – 1:00 p.m. EST. The final rule was displayed at the Federal Register on December 20, 2016 and is effective on February 18, 2017.
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http://innovation.cms.gov
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February 9, 2012
These slides are designed for Post-Acute Care (PAC) providers seeking additional information about how Model 3 works and a better understanding of the opportunities for PAC providers within the Bundled Payment for Care Improvement (BPCI) initiative to achieve better care, better health and lower costs for their patients through care redesign.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Model-3-Deep-Dive.html
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CMS Innovation Center
http://innovation.cms.gov
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The Centers for Medicare & Medicaid Services hosted a webinar on Thursday, April 2, 2020 to discuss the Value Based Insurance Design (VBID), Part D Payment Modernization, and Part D Senior Savings models. Attendees received an overview of the models and the CY 2021 application process, and had an opportunity for questions and answers with the Model teams.
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CMS Innovation Center
http://innovation.cms.gov
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During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 11, 2019 from 1:30pm-3:00 p.m. EST entitled, Direct Contracting Overview/Direct Contracting Entity (DCE) Types/Alignment. During this webinar, presenters provided an overview of the Direct Contracting Model Professional and Global Options, including information about the participation and eligibility requirements, Direct Contracting Entity (DCE) types, payment mechanisms, and beneficiary alignment methodology.
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CMS Innovation Center
http://innovation.cms.gov
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The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered questions.
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CMS Innovation Center
http://innovation.cms.gov
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The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
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CMS Innovation Center
http://innovation.cms.gov
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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
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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:
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 a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model final rule on Wednesday, February 22, 2017, from 12:00 p.m. – 1:00 p.m. EST. The final rule was displayed at the Federal Register on December 20, 2016 and is effective on February 18, 2017.
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CMS Innovation Center
http://innovation.cms.gov
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February 9, 2012
These slides are designed for Post-Acute Care (PAC) providers seeking additional information about how Model 3 works and a better understanding of the opportunities for PAC providers within the Bundled Payment for Care Improvement (BPCI) initiative to achieve better care, better health and lower costs for their patients through care redesign.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Model-3-Deep-Dive.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 Centers for Medicare & Medicaid Services hosted a webinar on Thursday, April 2, 2020 to discuss the Value Based Insurance Design (VBID), Part D Payment Modernization, and Part D Senior Savings models. Attendees received an overview of the models and the CY 2021 application process, and had an opportunity for questions and answers with the Model teams.
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CMS Innovation Center
http://innovation.cms.gov
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http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 11, 2019 from 1:30pm-3:00 p.m. EST entitled, Direct Contracting Overview/Direct Contracting Entity (DCE) Types/Alignment. During this webinar, presenters provided an overview of the Direct Contracting Model Professional and Global Options, including information about the participation and eligibility requirements, Direct Contracting Entity (DCE) types, payment mechanisms, and beneficiary alignment methodology.
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CMS Innovation Center
http://innovation.cms.gov
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http://newmedia.hhs.gov/standards/comment_policy.html
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The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered 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
This webinar is designed to ensure that all applicants to Models 2-4 of BPCI have a clear understanding of the three different roles an applicant must choose from when applying to this initiative. The applicant roles are linked to the applicant's partner types, as well as to how the applicant decides to partner with these Bundled Payment participating organizations.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Applicant-Roles.html
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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
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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.
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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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In this webinar, staff from the CMS Innovation Center provided an overview of the Demonstration, and offered information about how to apply.
More at: http://www.innovations.cms.gov/resources/GNE_overview.html
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CMS Innovation Center
http://innovation.cms.gov
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CMS Privacy Policy
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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:
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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
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The Primary Care First (PCF) Model Options team hosted a series of four informational webinars about the PCF Model Options. Topics discussed included the model options' aims, requirements, benefits of participation, and application next steps. Attendees had the opportunity to submit questions to the model options team during each of the webinars. Each of the webinars covered the same information.
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CMS Innovation Center
http://innovation.cms.gov
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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
We accept comments in the spirit of our comment policy:
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The CMS Innovation Center hosted a webinar on Tuesday, March 4, 2014 to discuss the Winter Open Period. This webinar included available information about the models, as well as the process and requirements for submitting requests for participation.
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CMS Innovation Center
http://innovation.cms.gov
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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.
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CMS Innovation Center
http://innovation.cms.gov
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CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
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CMS Innovation Center
http://innovation.cms.gov
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The Direct Contracting Model Options team hosted a webinar on January 15, 2020 to provide an overview of the Direct Contracting Model's payment methodology. During the session, the Direct Contracting model team presented key aspects of the Direct Contracting financial model, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.
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CMS Innovation Center
http://innovation.cms.gov
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The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options introduction webinar on Tuesday, November 12, 2019 from 12:00 p.m. - 1:00 p.m. EST.
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CMS Innovation Center
http://innovation.cms.gov
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In this Thursday, July 12, 2012 webinar, presentations focused on learning more about program requirements, preferences, and other keys to success from CMS Innovation Center staff and communities currently participating in the CCTP program. The final CCTP review panel for 2012 convened on September 20, 2012. Applications must have been received by September 3rd to be considered for this review. Future panels may be announced as funding permits.
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http://innovation.cms.gov
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The Center for Medicare & Medicaid Services (CMS) recently announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.
This webinar will allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.
More at: http://innovations.cms.gov/resources/CCTP-RdcReadmiss.html
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http://innovation.cms.gov
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The Maternal Opioid Misuse (MOM) Model team presented a notice of funding opportunity and application review webinar on Thursday, February 21 from 2:00 p.m. to 3:15 p.m. EST.
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CMS Innovation Center
http://innovation.cms.gov
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The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
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CMS Innovation Center
http://innovation.cms.gov
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As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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CMS Innovation Center
http://innovation.cms.gov
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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
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The CMS Innovation Center hosted a webinar on Wednesday April 9, 2014 to provide an overview of the Medicare Care Choices Model and the application process. Subject matter experts from the CMS Innovation Center provided details and answered questions.
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http://innovation.cms.gov
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On Thursday, April 18 from 1:00 p.m. - 2:00 p.m. EDT the Artificial Intelligence (AI) Health Outcomes Challenge team provided an informational overview of the challenge.
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CMS Innovation Center
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The CMS Innovation Center held the third in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Tuesday, June 18, 2013 from 1:30–3:00pm EDT, focused on the remaining two of the four innovation categories.
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CMS Innovations
http://innovations.cms.gov
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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 second of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
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CMS Innovation Center
http://innovation.cms.gov
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This webinar is designed to ensure that all applicants to Models 2-4 of BPCI have a clear understanding of the three different roles an applicant must choose from when applying to this initiative. The applicant roles are linked to the applicant's partner types, as well as to how the applicant decides to partner with these Bundled Payment participating organizations.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Applicant-Roles.html
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
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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.
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CMS Innovation Center
http://innovation.cms.gov
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In this webinar, staff from the CMS Innovation Center provided an overview of the Demonstration, and offered information about how to apply.
More at: http://www.innovations.cms.gov/resources/GNE_overview.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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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:
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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:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
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The Primary Care First (PCF) Model Options team hosted a series of four informational webinars about the PCF Model Options. Topics discussed included the model options' aims, requirements, benefits of participation, and application next steps. Attendees had the opportunity to submit questions to the model options team during each of the webinars. Each of the webinars covered the same information.
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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 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
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, March 4, 2014 to discuss the Winter Open Period. This webinar included available information about the models, as well as the process and requirements for submitting requests for participation.
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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 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.
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CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
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The Direct Contracting Model Options team hosted a webinar on January 15, 2020 to provide an overview of the Direct Contracting Model's payment methodology. During the session, the Direct Contracting model team presented key aspects of the Direct Contracting financial model, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.
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The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options introduction webinar on Tuesday, November 12, 2019 from 12:00 p.m. - 1:00 p.m. EST.
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In this Thursday, July 12, 2012 webinar, presentations focused on learning more about program requirements, preferences, and other keys to success from CMS Innovation Center staff and communities currently participating in the CCTP program. The final CCTP review panel for 2012 convened on September 20, 2012. Applications must have been received by September 3rd to be considered for this review. Future panels may be announced as funding permits.
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The Center for Medicare & Medicaid Services (CMS) recently announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.
This webinar will allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.
More at: http://innovations.cms.gov/resources/CCTP-RdcReadmiss.html
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The Maternal Opioid Misuse (MOM) Model team presented a notice of funding opportunity and application review webinar on Thursday, February 21 from 2:00 p.m. to 3:15 p.m. EST.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
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As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
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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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The CMS Innovation Center hosted a webinar on Wednesday April 9, 2014 to provide an overview of the Medicare Care Choices Model and the application process. Subject matter experts from the CMS Innovation Center provided details and answered questions.
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On Thursday, April 18 from 1:00 p.m. - 2:00 p.m. EDT the Artificial Intelligence (AI) Health Outcomes Challenge team provided an informational overview of the challenge.
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The CMS Innovation Center held the third in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Tuesday, June 18, 2013 from 1:30–3:00pm EDT, focused on the remaining two of the four innovation categories.
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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 second of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
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The CMS Innovation Center held the seventh in a series of webinars on Thursday, July 18, 2013 from 1:00–2:00pm EDT to provide an overview of the application package.
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The CMS Innovation Center held the eighth in a series of webinars about the Health Care Innovation Awards Round Two on Wednesday, July 24, 2013 from 1:00–2:00pm EDT to provide technical assistance on submitting an application.
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In this July 11, 2012 webinar, CMS Innovation Center staff discussed the amended Funding Opportunity Announcement (FOA) for the Strong Start for Mothers and Newborns initiative.
More at: http://www.innovations.cms.gov/resources/StrongStart_FOA.html
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CMS hosted an Open Door Forum call on November 22, 2013 to allow providers, suppliers, beneficiary advocacy groups, and other interested parties to provide input into the design and implementation of this demonstration. Mandated by the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (P.L. 112-242)”, the purpose of this demonstration is to evaluate the impact of providing payment for items and services needed for the in-home administration of IVIG for the treatment of primary immune deficiency disease (PIDD). The demonstration will provide these benefits for up to 4,000 Medicare beneficiaries for a period of three years.
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The CMS Innovation Center held the second in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Wednesday, June 8, 2016 from 12:00p.m. – 1:30p.m. EDT. This webinar consisted of a panel discussion focusing on learning from past ESCO participants on what it takes to become a successful applicant and successful ESCO.
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In this August 15, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Testing award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
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The CMS Innovation Center held the fourth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, June 20, 2013 from 1:00–2:00pm EDT, focused on how to achieve lower costs through improvement. This webinar also reviewed the components of the Financial Plan.
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CMS Innovation Center staff hosted a webinar for state officials on Tuesday, August 28, 2012 from 3:00pm to 4:00pm ET to provide additional information on the application process, financial templates and accessing Medicare data.
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Strong Start is an initiative to reduce preterm births and early elective deliveries while improving outcomes for newborns and pregnant women.
Under this initiative, the Innovation Center will award up to $43 million through a competitive process to providers, States, managed care plans, and conveners to achieve better care, improved health, and lower costs for these women and their newborns.
CMS Innovation Center and Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can prepare their budget for the Strong Start Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_McaidFundOpp.html
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The State Innovation Models initiative is a competitive funding opportunity for states to design and test multi-payer payment and service delivery models that deliver high-quality health care and improve health system performance.
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The CMS Innovation Center hosted a webinar on Wednesday, July 2, 2014, from 4:15pm-5:15pm EDT. The webinar reviewed Model Test Proposal Format Requirements, the ‘Population Health Plan’ Portion of the Model Test Project Narrative, and the Population Health Plan Deliverable of the Model Test Project Period.
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CMS Innovation Center staff hosted this webinar for state officials to provide additional information on the application process, financial templates and accessing Medicare data.
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Staff from the CMS Innovation Center hosted an overview webinar of the Health Care Innovation Awards Round Two to give interested potential applicants the opportunity to hear more about the Funding Opportunity Announcement. CMS Innovation Center staff were also available to answer questions. Advance registration was required.
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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
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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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The CMS Innovation Center hosted a repeat of the Thursday, November 6 ACO Investment Model webinar on Tuesday, November 18, 2014, from 2:30pm-3:30pm EST. The webinar provided guidance on the ACO Investment Model (AIM) application to prospective ACO applicants. The webinar included a review of the model eligibility requirements and an explanation of each application question including the spend plan narrative and spreadsheet.
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Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Practical considerations in enabling new models of care, pop up uni, 10am, 3 ...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The acceleration in the rate of increase of healthcare costs have been attributed to a number of factors, principally
The public’s increasing demand for health services. The ever-growing technology of health care.
The probably higher quality of care now being delivered.
General inflation.
The lack of incentives in medical care to keep costs down.
The increasing practice of “defensive medicine” in which diagnostic tests and prescribed treatment are aimed at avoiding lawsuits rather than at meeting the patients real needs.
Private Fee for Service the two party arrangement is the traditional form of reimbursement for dental services in most countries
Post payment Plans first introduced in the late 1930’s by local dental societies in Pennsylvania and Michigan.
It is also known as budget payment plans.
. Private Third Party Prepayment for dental services is defined as “payment for services by some agency rather than directly by the beneficiary of those services”
A capitation fee is defined as a fixed monthly or yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment.
The money is paid regardless of whether the patients participate in the plan, receive no care, a little care or great deal of care
How do medicaid waivers expand the possibilities of whole person care 032117Jennifer D.
With the changing landscape in healthcare right now it's important to know how Medicaid Waivers and Whole Person Care can help secure positive outcomes.
Running header THE CURRENT FINANCIAL ENVIRONMENT IN HEALTHCARE AN.docxjeffsrosalyn
Running header: THE CURRENT FINANCIAL ENVIRONMENT IN HEALTHCARE AND ITS INFLUENCE ON DECISION MAKING
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THE CURRENT FINANCIAL ENVIRONMENT IN HEALTHCARE AND ITS INFLUENCE ON DECISION MAKING
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The Current Financial Environment in Healthcare and its Influence on Decision Making
It is essential that healthcare managers understand the external factors that have a profound influence on the practice of healthcare finance. A key factor to understanding healthcare finance is the knowledge of all the different and unique setting that provide health services. Healthcare services are provided in numerous settings, including hospitals, ambulatory care offices and clinics, long-term care facilities, and integrated delivery systems.
Hospitals afford diagnostic and therapeutic services to those who need more than several hours of care. Hospitals must be licensed by the state and undergo inspections for compliance with state regulations (Gapenski 2013). Most hospitals are accredited by The Joint Commission, which is intended to promote high standards of care. Accreditation provides eligibility for participation in the Medicare and Medicaid programs.
Hospitals are classified as either general acute care facilities or specialty facilities. General acute care facilities provide general medical and surgical services and selected acute specialty services (Gapenski 2013). These facilities account for most hospitals and have comparatively short spans of stay. Specialty hospitals limit the admission of patients to specific ages, sexes, illnesses, or conditions (Gapenski 2013). Specialty hospitals frequently sustain lower expenses than general hospitals because they do not need the overhead connected with providing various diverse forms of care and services.
Hospitals are classified by proprietorship as governmental, private not-for-profit, or investor owned. Government hospitals constitute 25% of all hospitals and are divided into federal and public entities. Federal hospitals serve special purposes such as DOD and VA hospitals. Public hospitals are funded wholly or in part by a city, county, tax district, or state. Federal and Public hospitals provide substantial services to indigent patients (Gapenski 2013). Private not-for-profit hospitals are nongovernment entities organized for the sole purpose of providing inpatient healthcare services (Gapenski 2013). Roughly 80% of all private hospitals are not-for-profit entities and 60% of all hospitals are private hospitals. For serving a charitable purpose, these hospitals obtain several benefits, including exemption from federal and state income taxes, exemption from property and sales taxes, eligibility to receive tax-deductible charitable contributions, favorable postal rates, favorable tax-exempt financing, and tax-favored annuities for employees. The residual 15% of all hospitals are investment-owned hospitals, whose titleholders profit directly from the revenues created by .
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. Focus of this proposal include gestational diabetes, maternal obesity, postpartum weight loss, and as well as patient engagement / health literacy
Similar to Webinar: Initiative to Reduce Avoidable Hospitalizations - Overview and How to Apply (20)
The Medicare Advantage Value-Based Insurance Design (VBID) Model team at the Center for Medicare and Medicaid Innovation (CMMI) and national leaders participated in a discussion around pathways for addressing food and nutritional insecurity at webinar event of our Health Equity Incubation Program on Thursday, March 31, 2022, from 3:00-4:30 PM ET.
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The CMS Innovation Center hosted an office hours session on Tuesday, April 5, 2022 from 3:00-4:00 PM ET to discuss the Medicare Advantage Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component. Attendees received an overview of the Model and the CY 2023 application process, and had an opportunity for questions and answers with the Model team.
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The ACO REACH Model Team will hosted a health equity webinar on Tuesday, April 5, 2022 from 4:00 - 5:00 p.m. EDT. The ACO REACH Model team highlighted Health Equity provisions added to the ACO REACH Model.
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This webinar focuses on the new financial policies featured in the ACO REACH webinar. For more information on the financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model, please refer to prior released financial webinars available on the GPDC Model webpage.
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During this webinar, a high-level overview of the ACO REACH Model was provided including information on the participation and eligibility requirements, Accountable Care Organization (ACO) types, payment mechanisms, and beneficiary alignment methodology.
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The CMS Innovation Center will host a webinar on Thursday, March 10, 2022 from 3:00-4:00 PM ET. During this webinar, presenters will provide a brief review of the recently released Calendar Year (CY) 2023 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component as well as the payment design related to the Hospice Benefit Component of the VBID Model. This session will also offer attendees an opportunity to ask follow-up questions.
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This webinar provided an overview of the Model and the Part D Sponsor application process, as well as included a Q&A session for interested Part D sponsors.
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The CMS Innovation Center hosted a webinar on Wednesday, March 2, 2022 at 3pm – 4pm ET, during which presenters shared updates on the Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model, the Kidney Care Choices (KCC) Model, and the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. This event was available to the first 1,000 registrants. Presentation materials will be available on the respective model webpages following the session.
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The Medicare Advantage Value-Based Insurance Design (VBID) Model Team hosted an office hours session on Thursday February 3rd, 2022 on the Hospice Benefit Component to provide technical and operational support to interested stakeholders. During this office hours session, presenters answered questions submitted in advance to the VBID Mailbox and offered attendees an opportunity to ask additional questions.
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Has your organization prioritized addressing health inequities? How can a Center for Medicare and Medicaid Innovation (CMMI) Model factor into your organization’s health equity strategy? How can you structure your plan’s benefits to have the greatest impact on underserved communities? What partnership opportunities are available with CMMI?
These are important questions CMMI plans to answer in a new webinar series focused on health equity! CMMI is sponsoring a series of webinars for current and potential Medicare Advantage Organization (MAO) participants in the Value-Based Insurance Design (VBID) Model.
The first webinar in the series provided an overview of the Model’s Health Equity Incubation Sessions effort, articulated a business case for MAOs to leverage VBID Model Components to address health inequities in their member populations, and provided specific guidance and clarification on the full extent of health equity focused flexibilities that fall under the Model’s waiver authority.
- - -
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 ET3 Model and Medicaid: Opportunities for Alignment webinar provided background on the ET3 Model, discussed the benefits for states of aligning coverage and payment policies with ET3, and explored considerations for states seeking to implement new Medicaid services that align with the ET3 Model. This webinar was intended for state Medicaid agencies, ET3 Model Participants, and other stakeholders interested in learning more about optional Medicaid alignment with the ET3 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
CMS announced an Office Hour event for potential applicants to ask questions ahead of the PCF application deadline.
The PCF Model Team was available to answer questions on key topics including eligibility, payment design and attribution, and more.
You may also refer to the materials from the two PCF webinars held in March: Introduction to PCF and Ready, Set, Apply.
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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
In order to help ETC Model Participants prepare for the ETC Model, CMS conducted an introductory webinar on Wednesday, December 9, 2020 from 1 p.m. to 2 p.m. The webinar provided an overview of the ETC Model, including:
Participant selection
The Home Dialysis Payment Adjustment
The Performance Payment Adjustment
The ETC Model timeline, including the timing of payment adjustments
Information about how to communicate with CMS about the ETC 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 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 Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Wednesday, March 17, 2021 from 4:00 - 5:00 PM EDT. During this webinar, presenters provided a preview of the Calendar Year 2022 payment design related to the Hospice Benefit Component of the VBID Model. The 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 Part D Senior Savings Model and Part D Payment Modernization Model teams hosted a webinar on Tuesday, March 23, 2021 from 1:00 to 2:00 PM EDT. During this webinar, presenters provided an overview of the two Models and the Calendar Year (CY) 2022 application process. The 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
CMS hosted a virtual office hour session on April 13, 2021 from 4:00-5:00 PM EDT. During this office hour, presenters provided a review of the Calendar Year 2022 payment design and payment rates related to the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. 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 Emergency Triage, Treat, and Transport (ET3) Model Medical Triage Line Notice of Funding Opportunity (NOFO) webinar provided an overview of the application process and NOFO requirements for implementing 911 medical triage lines. This webinar was intended for those interested in learning more about the ET3 Model’s Notice of Funding Opportunity, which was released March 12.
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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 Primary Care First Model (PCF) Options team provided an overview of the PCF payer partnership. Participants were able to learn about current PCF Model participants, benefits to payer partnership, the framework against which payer proposal alignment will be evaluated, and the payer solicitation process and timeline.
- - -
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 provided an overview of the Model, including goals, eligibility to participate in the second cohort, payment design and attribution, and data sharing. Model staff answered your questions about these topics.
- - -
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
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Up the Ratios Bylaws - a Comprehensive Process of Our Organizationuptheratios
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Webinar: Initiative to Reduce Avoidable Hospitalizations - Overview and How to Apply
1. Initiative to Reduce Avoidable
Hospitalizations Among
Nursing Facility Residents
CMS Medicare-Medicaid Coordination Office and
Center for Medicare & Medicaid Innovation
2. Avoidable hospitalization among
nursing facility residents
• Two-thirds of nursing facility residents are enrolled in Medicaid, and most
are also enrolled in Medicare (Medicare-Medicaid enrollees).
• Nursing facility residents are frequently subject to avoidable inpatient
hospitalizations.
• These hospitalizations are expensive, disruptive, and disorienting, and
nursing facility residents are vulnerable to risks that accompany hospital
stays and transitions between nursing facilities and hospitals.
• Avoidable hospitalizations among nursing facility residents stem from
multiple system failures.
1
3. Evidence that hospitalizations
can be avoided
• Studies have estimated that 30% to 67% of hospitalizations among nursing
facility residents could be prevented with well-targeted interventions
(Jacobson, et. al., 2010).
• 45% of hospital admissions among Medicare-Medicare enrollees receiving
Medicare skilled nursing or Medicaid nursing facility services could have
been avoided (Walsh et. al, 2010).
o 314,000 potentially avoidable hospitalizations
o $2.6 billion in Medicare expenditures in 2005
• Past interventions have proven effective:
o Evercare reduced hospital admissions by 47% and emergency department use
by 49% (Kane, et. al, 2004).
o Nursing facility-employed staff provider model in NY reduced Medicare costs by
16.3% (Moore & Martelle, 1996).
o INTERACT II reduced hospital admissions by 17% (Ouslander, et. al., 2011).
2
4. Initiative to Reduce Avoidable
Hospitalizations among NF Residents
• Joint Initiative of the Center for Medicare and Medicaid Innovation
(Innovation Center) and the Medicare-Medicaid Coordination Office
(MMCO).
• Primary objectives:
o Reduce the frequency of avoidable hospital admissions and
readmissions;
o Improve resident health outcomes;
o Improve the process of transitioning between inpatient hospitals and
nursing facilities; and
o Reduce overall health care spending without restricting access to
care or choice of providers.
3
5. Intervention Requirements
• CMS will select awardees through a competitive process.
• CMS is not prescribing a specific clinical model.
• However, all interventions must include the following activities:
o Hire staff who maintain a physical presence on site at nursing
facilities and partner with nursing facility staff to implement
preventive services;
o Work in cooperation with existing providers;
o Facilitate residents’ transitions to and from inpatient hospitals and
nursing facilities;
o Provide support for improved communication and coordination
among existing providers; and
o Coordinate and improve management and monitoring of
prescription drugs, including psychotropic drugs.
4
6. Intervention Requirements
(cont.)
• Demonstrate a strong evidence base.
• Demonstrate strong potential for replication and sustainability in other
communities and institutions.
• Supplement (rather than replace) existing care provided by nursing
facility staff.
• Coordinate closely with State Medicaid and State survey & certification
agencies and State public health and health reform efforts.
• Allow for participation by nursing facility residents without any need for
residents or their families to change providers or enroll in a health plan.
5
7. Other Considerations
Proposed interventions may also include, but are not limited to:
– Education efforts with families/caregivers;
– Support for residents and nursing facility staff to facilitate a
successful discharge to the community as appropriate;
– Health information technology tools to support sharing of care
summaries across transitions in care and maintenance of
accurate, up-to-date medication lists (e.g., EHR, Health
Information Exchange, telemedicine);
– Enhanced behavioral health assessments, treatment, and
management.
6
8. Target Population
• Primary target population is fee-for-service, long-stay Medicare-Medicaid
enrollees in nursing facilities.
• Clinical interventions will focus on long-stay residents rather than those likely
to experience a brief post-acute stay and then return home.
• Applicants must describe how they will target their proposed intervention to
long-stay beneficiaries.
• CMS prefers that an intervention at a facility target all long-stay Medicare-
Medicaid enrollees residing in the facility, as opposed to a subset of them.
7
9. Eligibility Guiding Principles
• Isolate measurement of new interventions or services on
fee-for-service, long-stay Medicare/Medicaid enrollees:
– Demonstrate impact above and beyond other services and
models
– Ensure beneficiary protections
– Adhere to intervention requirements
NOTE: CMS will not provide individual confirmation
of an organization’s eligibility until after submission
of a full application.
8
10. Eligible Applicants
• CMS will make cooperative agreement awards to “enhanced care & coordination
providers” to implement interventions.
• Eligible applicants may include but are not limited to:
o Organizations that provide care coordination, case management, or related
services
o Medical care providers, such as physician practices
o Health plans (although this Initiative will not be capitated managed care, and will not
apply to beneficiaries enrolled in Medicare Advantage)
o Public or not-for-profit organizations, such as Aging and Disability Resource
Centers, Area Agencies on Aging, Behavioral Health Organizations, Centers for
Independent Living, universities, or others
o Integrated delivery networks, if they extend their networks to include unaffiliated
nursing facilities
• Non-profit and for-profit organizations are eligible to apply.
9
11. Entities Not Eligible to Apply
• Nursing facilities, entities controlled by nursing facilities, or entities for
which the primary line of business is the delivery of nursing facility /
skilled nursing facility services are not eligible to serve as enhanced
care & coordination providers.
• Nursing facilities are essential partners in implementing this Initiative.
• We are only planning to implement this Initiative at nursing facilities
that are willing partners.
10
12. Organizations Generally Eligible
• Generally eligible:
– Individual hospitals
– Physician practices
– Public or private, not-for-profit/for-profit organizations (e.g., Aging
and Disability Resource Centers, Area Agencies on Aging,
Behavioral Health Organizations, Centers for Independent
Living, universities)
– Care management / coordination companies
• Cannot be controlled by a nursing facility or have delivery of nursing
facility / skilled nursing facility service as its primary line of business
11
13. Organizations Generally Eligible
But…
• Generally eligible if partner with unaffiliated nursing facilities:
– Assisted living, independent living, and CCRCs
– Integrated delivery networks or health systems
– Entities with common nursing facility ownership, management, or
other related operations (e.g., physician practices, therapy
companies, hospice)
• Health plans are generally eligible, but this Initiative is not managed
care and must ensure beneficiary protections.
• Cannot be controlled by a nursing facility or have delivery of nursing
facility / skilled nursing facility service as its primary line of business.
12
14. Other Federal Initiatives
• CMS is not seeking to fund interventions that compete or interfere
with existing demonstrations.
• Organizations participating in other Federal initiatives (e.g.,
Accountable Care Organization models, Community- Based Care
Transitions program, Bundled Payment for Care Improvement) must:
– Disclose current participation and notification of future participation
– Describe how participation in this Initiative will complement and support
other initiatives
– Ensure no duplicative funding or sharing Medicare savings for the same
individuals served through this Initiative
– Describe how the unique impact of this Initiative will be measured above
and beyond existing initiatives.
– See Restrictions / Limitations section on pages 11-13 of the funding
opportunity announcement.
13
15. Billing
• Practitioners funded through this Initiative will not be
permitted to separately bill Medicare or Medicaid for services
delivered to the nursing facility residents involved in this
Initiative.
• For example, if an awardee (enhanced care & coordination
provider) hires nurse practitioners as part of this Initiative,
those nurse practitioners cannot also bill Medicare or
Medicaid for services rendered to nursing facility residents at
the facilities participating in this Initiative. (See Section 4.5 on
page 21 of the funding opportunity announcement.)
14
16. Nursing Facility Partnerships
• Success in achieving the aims of this Initiative will depend on both the
strength and efficacy of the clinical intervention and the effectiveness
of engagement between the enhanced care & coordination provider
and its partnering nursing facilities.
– Nursing facility participation is voluntary
– Applicants must demonstrate a high level of engagement with the nursing
facilities included in their application.
– Applications must include letters of intent from a minimum of 15 Medicare-
and Medicaid-certified nursing facilities within the same State, with an
average census of 100 residents or more per facility.
• The average census of 100 residents or more per facility is across all
15+ nursing facility partners rather than for each facility.
– Model should be implemented consistently across all nursing facilities.
15
17. Nursing Facility Partnerships
(cont.)
• Preference for implementation in geographic locations with high Medicare
costs, high hospital readmission rates, and where Medicare-Medicaid enrollees
represent a high percentage of nursing facility residents.
• Restrictions /Limitations on partnering facilities
• Facilities in which more than 25% of the residents (long-stay) are enrolled
in Medicare managed care;
• Hospital-based nursing facilities with a resident profile made up of less
than 50% of beneficiaries with Medicaid as their primary payer;
• Special focus facilities; or
• Nursing facilities with outstanding major survey violations for immediate
jeopardy to resident health or safety.
16
18. State Role
• States are critical partners in achieving this Initiative’s objectives.
– Play significant role in setting payment policy and monitoring quality of
care for nursing facility services.
• CMS is only interested in implementing this Initiative where States will be
willing partners.
• Requirements for Initiative application:
– All applicants must obtain a letter(s) of support from their State’s
Medicaid director and Survey and Certification director.
– States may, at their discretion, offer support to multiple applicants or
none at all.
– It is the applicant’s responsibility to obtain and submit the letter(s).
17
19. State Role (cont.)
• State role during implementation of the Initiative:
– In States where enhanced care & coordination providers are selected,
CMS will sign an MOU with State Medicaid and State survey and
certification agencies.
– State responsibilities under the MOU include:
• Provide Medicaid claims data to support monitoring and evaluation (State
Medicaid agency)
• Communicate the State’s support of the Initiative to surveyors and
participating nursing facilities (State survey and certification agency)
– CMS will keep States informed on implementation and evaluation, such
as through interim findings and learning and diffusion activities.
18
20. Funding
• Overall Initiative size: Approximately 7 cooperative agreement
awards to implement the Initiative in approximately 150 nursing
facilities.
• Please note that the approximately 150 nursing facilities is an estimate. The
actual number of nursing facility participants will depend upon the number of
partners proposed in the application.
• CMS is more interested in the quality of nursing facility partners than the overall
number, but applicants are encouraged to propose more than 15 partners in the
same State.
• Total funding is up to $128 million plus $6.4 million in supplemental
funds that may be allocated based on operational, quality, and
savings criteria.
• Awards expected to range from $5 million to $30 million for each
enhanced care & coordination provider over a 4-year period.
19
21. Multi-State Applications
• CMS anticipates that each award will take place in one
State.
• Applicants may propose to implement an intervention in
multiple States but its application must include:
– Letters of support from each State Medicaid director and State
survey and certification director; and
– Letters of intent from at least 15 Medicare- and Medicaid-
certified nursing facilities in each State.
20
22. Implementation and Oversight
• CMS and its contractors will conduct program monitoring throughout the
cooperative agreement period of performance. These activities include:
– Conducting readiness reviews for each enhanced care & coordination provider
prior to implementing its clinical intervention;
– Conducting quarterly chart reviews of a sample of nursing facility residents to
ensure that hospital care is not being inappropriately withheld;
– Establishing, organizing, and leading learning and diffusion activities;
– Calculating annual quality scores and combined Medicare and Medicaid savings
estimates to assist CMS in determining supplemental funds awards; and
– Monitoring enhanced care & coordination provider compliance with Medicare and
Medicaid billing restrictions.
21
23. Evaluation
• CMS will contract with an outside evaluator.
• It will include a broad set of evaluation measures, such as:
– Hospitalization rate
– Readmission rate
– Quality of care
– Resident experience
– Medicare expenditures
– Medicaid expenditures
22
24. Next Step: Notice of Intent to
Apply
• Potential applicants must submit a non-binding Notice of Intent to Apply (NOIA) to be eligible
for a funding award.
• NOIAs are due by 3:00 PM Eastern Time on May 7, 2012
• NOIAs must include the following information:
– Name of the applicant organization;
– Name(s) of any operating partners (for other services, not nursing facility partners);
– Name of organization point of contact, including:
• Phone number;
• Email address;
– The organization’s location;
– Proposed target geographic location of the proposed intervention; and
– State in which it is considering implementing the Initiative.
• NOIAs can be submitted at: http://www.innovations.cms.gov/initiatives/rahnfr/index.html
23
25. Other Key Dates
• Full applications due by 3:00 PM on June 14, 2012.
– Organizations are encouraged to apply in advance of this date.
– See full application requirements starting on page 33 of the funding
opportunity announcement.
– Must be submitted through http://www.grants.gov/
• Awards anticipated August 24, 2012.
• Start-up activities, including readiness reviews, must be completed before
implementation begins.
– See page 18 of the funding opportunity announcement for schedule of
deliverables.
• Anticipated period of performance: August 2012 to August 2016.
24
26. More Information
• Visit the following websites for more information:
http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-
Medicaid-Coordination/Medicare-Medicaid-Coordination-
Office/ReducingPreventableHospitalizationsAmongNursingFacilityResidents
.html
http://www.innovations.cms.gov/initiatives/rahnfr/index.html
• To apply, please see http://www.grants.gov/ by searching for
CFDA Number 93.621.
• Email questions to: NFInitiative2012@cms.hhs.gov. Programmatic
questions received after May 31, 2012 are not guaranteed a response.
25
27. Other Resources
• CMS Office of Clinical Standards and Quality / Survey & Certification Group
Memorandum to State Survey Agency Directors, March 16, 2012:
– http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/SurveyCertificationGenInfo/Downloads/SC12-23-Opportunity-to-
Reduce-Need-for-Hospitalizations.pdf
• MMCO - Innovation Center – CMCS Informational Bulletin, March 23, 2012:
– http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-03-23-12.pdf
26