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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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
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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
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During this webinar the Primary Care First Model Options team provided an introduction to the Primary Care First Model that is geared towards payers, presented and answered questions live on topics related to payer partnership, including the Primary Care First payer alignment framework, benefits of multi-payer partnership, and the payer solicitation elements and selection process.
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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 Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted the first of two webinars on November 19 to describe the final rule and respond to questions about the Comprehensive Care for Joint Replacement Model.
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CMS Innovation Center
http://innovation.cms.gov
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This was the second event in a two-part webinar series on the Primary Care First Seriously Ill Population (SIP) payment model option. During this webinar, the Primary Care First Model Options team reviewed additional details about the SIP payment model option. This webinar built upon what was discussed during the first SIP webinar held on July 24, 2019 and provided an opportunity for attendees to submit live questions.
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CMS Innovation Center
http://innovation.cms.gov
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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
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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 proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
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CMS Innovation Center
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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
We accept comments in the spirit of our comment policy:
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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:
http://newmedia.hhs.gov/standards/comment_policy.html
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During this webinar the Primary Care First Model Options team provided an introduction to the Primary Care First Model that is geared towards payers, presented and answered questions live on topics related to payer partnership, including the Primary Care First payer alignment framework, benefits of multi-payer partnership, and the payer solicitation elements and selection process.
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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 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
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 & Medicaid Innovation (CMS Innovation Center) hosted the first of two webinars on November 19 to describe the final rule and respond to questions about the Comprehensive Care for Joint Replacement Model.
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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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This was the second event in a two-part webinar series on the Primary Care First Seriously Ill Population (SIP) payment model option. During this webinar, the Primary Care First Model Options team reviewed additional details about the SIP payment model option. This webinar built upon what was discussed during the first SIP webinar held on July 24, 2019 and provided an opportunity for attendees to submit live questions.
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CMS Innovation Center
http://innovation.cms.gov
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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 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 proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
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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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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 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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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
http://innovation.cms.gov
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The Million Hearts: Cardiovascular Disease Risk Reduction Model team hosted an open door forum on Thursday, September 3, 2015. Attendees received an overview of the application as well an opportunity for question and answers about the Model. Joining the team was Paul Meissner, Director of Research Program Development at Montefiore Medical Center, who talked about why the Model is important to his organization.
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CMS Innovation Center
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 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 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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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.
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CMS Innovation Center
http://innovation.cms.gov
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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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CMS Innovation
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 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 CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
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http://innovation.cms.gov
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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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This webinar will highlight key areas from the document discussing what a strong application to the BPCI initiative should include. We encourage you to review the Models 2-4 application questions and the new Application Guidance document posted on the Bundled Payments for Care Improvement webpage, prior to this webinar.
More at: http://www.innovations.cms.gov/resources/Bundled-Payments-Application-Guidance.html
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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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The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing a application overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum washeld on Tuesday, March 29 from 4:00pm – 5:30pm EDT.
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CMS Innovation Center
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The CMS Innovation Center held the sixth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, July 11, 2013 from 1:00–2:00pm EDT, focused on developing payment models.
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CMS Innovations
http://innovations.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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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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CMS Innovation Center
http://innovation.cms.gov
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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 Innovations
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During this event, the Primary Care First, Direct Contracting, and Kidney Care Choices model teams discussed areas such as model aim, timeline, participant eligibility, and more. Attendees had the opportunity to submit questions during a live Q&A portion.
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CMS Innovation Center
http://innovation.cms.gov
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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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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
- - -
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 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
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 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
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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The Million Hearts: Cardiovascular Disease Risk Reduction Model team hosted an open door forum on Thursday, September 3, 2015. Attendees received an overview of the application as well an opportunity for question and answers about the Model. Joining the team was Paul Meissner, Director of Research Program Development at Montefiore Medical Center, who talked about why the Model is important to his organization.
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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 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
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 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 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
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.
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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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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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CMS Innovation
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
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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 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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The CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
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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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This webinar will highlight key areas from the document discussing what a strong application to the BPCI initiative should include. We encourage you to review the Models 2-4 application questions and the new Application Guidance document posted on the Bundled Payments for Care Improvement webpage, prior to this webinar.
More at: http://www.innovations.cms.gov/resources/Bundled-Payments-Application-Guidance.html
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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 Innovation (CMS Innovation Center) hosted an open door forum providing a application overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum washeld on Tuesday, March 29 from 4:00pm – 5:30pm EDT.
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The CMS Innovation Center held the sixth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, July 11, 2013 from 1:00–2:00pm EDT, focused on developing payment models.
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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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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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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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During this event, the Primary Care First, Direct Contracting, and Kidney Care Choices model teams discussed areas such as model aim, timeline, participant eligibility, and more. Attendees had the opportunity to submit questions during a live Q&A portion.
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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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The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
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4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
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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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Jean Moody Williams
The Medicare Access and CHIP Reauthorization Act of 2015 is fundamentally transitioning the U.S. Healthcare System from a Fee-For-Service model to a Fee-For-Value reimbursement model. MACRA encourages healthcare providers to utilize HIT, population health management, and care coordination in pursuit of The Triple Aim (Improving individual healthcare quality, improving population health , and reducing cost).
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
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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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CMS Innovation Center
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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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CMS Innovation Center
http://innovation.cms.gov
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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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CMS Innovation Center
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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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CMS Innovation Center
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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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CMS Innovation Center
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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.
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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
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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.
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CMS Innovation Center
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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
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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
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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
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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 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.
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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.
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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.
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The Community Health Access and Rural Transformation (CHART) Model team hosted an overview webinar on Tuesday, August 18, 2020 from 1:00 - 2:30 PM EDT. Attendees had the opportunity to hear an overview of the CHART Model, including its objectives, eligible participants and their roles, payment options, and timeline.
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More from Centers for Medicare & Medicaid Services (CMS) (20)
This session provides a comprehensive overview of the latest updates to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (commonly known as the Uniform Guidance) outlined in the 2 CFR 200.
With a focus on the 2024 revisions issued by the Office of Management and Budget (OMB), participants will gain insight into the key changes affecting federal grant recipients. The session will delve into critical regulatory updates, providing attendees with the knowledge and tools necessary to navigate and comply with the evolving landscape of federal grant management.
Learning Objectives:
- Understand the rationale behind the 2024 updates to the Uniform Guidance outlined in 2 CFR 200, and their implications for federal grant recipients.
- Identify the key changes and revisions introduced by the Office of Management and Budget (OMB) in the 2024 edition of 2 CFR 200.
- Gain proficiency in applying the updated regulations to ensure compliance with federal grant requirements and avoid potential audit findings.
- Develop strategies for effectively implementing the new guidelines within the grant management processes of their respective organizations, fostering efficiency and accountability in federal grant administration.
ZGB - The Role of Generative AI in Government transformation.pdfSaeed Al Dhaheri
This keynote was presented during the the 7th edition of the UAE Hackathon 2024. It highlights the role of AI and Generative AI in addressing government transformation to achieve zero government bureaucracy
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Up the Ratios Bylaws - a Comprehensive Process of Our Organizationuptheratios
Up the Ratios is a non-profit organization dedicated to bridging the gap in STEM education for underprivileged students by providing free, high-quality learning opportunities in robotics and other STEM fields. Our mission is to empower the next generation of innovators, thinkers, and problem-solvers by offering a range of educational programs that foster curiosity, creativity, and critical thinking.
At Up the Ratios, we believe that every student, regardless of their socio-economic background, should have access to the tools and knowledge needed to succeed in today's technology-driven world. To achieve this, we host a variety of free classes, workshops, summer camps, and live lectures tailored to students from underserved communities. Our programs are designed to be engaging and hands-on, allowing students to explore the exciting world of robotics and STEM through practical, real-world applications.
Our free classes cover fundamental concepts in robotics, coding, and engineering, providing students with a strong foundation in these critical areas. Through our interactive workshops, students can dive deeper into specific topics, working on projects that challenge them to apply what they've learned and think creatively. Our summer camps offer an immersive experience where students can collaborate on larger projects, develop their teamwork skills, and gain confidence in their abilities.
In addition to our local programs, Up the Ratios is committed to making a global impact. We take donations of new and gently used robotics parts, which we then distribute to students and educational institutions in other countries. These donations help ensure that young learners worldwide have the resources they need to explore and excel in STEM fields. By supporting education in this way, we aim to nurture a global community of future leaders and innovators.
Our live lectures feature guest speakers from various STEM disciplines, including engineers, scientists, and industry professionals who share their knowledge and experiences with our students. These lectures provide valuable insights into potential career paths and inspire students to pursue their passions in STEM.
Up the Ratios relies on the generosity of donors and volunteers to continue our work. Contributions of time, expertise, and financial support are crucial to sustaining our programs and expanding our reach. Whether you're an individual passionate about education, a professional in the STEM field, or a company looking to give back to the community, there are many ways to get involved and make a difference.
We are proud of the positive impact we've had on the lives of countless students, many of whom have gone on to pursue higher education and careers in STEM. By providing these young minds with the tools and opportunities they need to succeed, we are not only changing their futures but also contributing to the advancement of technology and innovation on a broader scale.
Many ways to support street children.pptxSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
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What is the point of small housing associations.pptxPaul Smith
Given the small scale of housing associations and their relative high cost per home what is the point of them and how do we justify their continued existance
Understanding the Challenges of Street ChildrenSERUDS INDIA
By raising awareness, providing support, advocating for change, and offering assistance to children in need, individuals can play a crucial role in improving the lives of street children and helping them realize their full potential
Donate Us
https://serudsindia.org/how-individuals-can-support-street-children-in-india/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool, #joyhome
Webinars: Primary Care First Model Options - Informational Webinar Series
1. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 1
Primary Care First
Foster Independence. Reward Outcomes.
Model Briefing
Center for Medicare & Medicaid Innovation
2. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 2
Primary Care First Builds on the Underlying
Principles of Prior CMS Innovation Models
1
2
CMS primary care models offer a variety of opportunities to advance
care delivery, increase revenue, and reduce burden.
Primary Care First rewards
outcomes, increases
transparency, enhances care for
high need populations, and
reduces administrative burden.
PCF
Comprehensive Primary
Care Plus (CPC+) Track 1 is
a pathway for practices ready
to build the capabilities to
deliver comprehensive primary
care.
CPC+ Track 2 is a pathway
for practices poised to
increase the
comprehensiveness of
primary care.
3. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 3
Primary Care First Rewards Value and Quality
Through an Innovative Payment Structure
1
2
To reduce Medicare spending by
preventing avoidable inpatient hospital
admissions
To improve quality of care and access to
care for all beneficiaries, particularly those
with complex chronic conditions and serious
illness
Primary Care First Goals Primary Care First Overview
Offers greater flexibility, increased
transparency, and performance-based
payments to participants
5-year alternative payment model
Fosters multi-payer alignment to provide
practices with resources and incentives to
enhance care for all patients, regardless of
insurer
Payment options for practices that specialize
in patients with complex chronic
conditions and high need, seriously ill
populations
CMS Primary Cares Initiatives
4. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 4
Primary Care First Will Be Offered in 26
States and Regions Beginning in 2021
Current CPC+ Track 1 and 2 regions New regions added in Primary Care First
In 2021, Primary Care First will include 26 diverse regions:
CMS Primary Cares Initiatives
5. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 5
Primary Care Practices Can Participate in
One of Three Payment Model Options
The three Primary Care First (PCF) payment models accommodate a
continuum of providers that specialize in care for different patient populations.
PCF-General
Component
SIP Component Both PCF-General and
SIP Components
1Option 2Option 3Option
Focuses on advanced
primary care practices
ready to assume financial
risk in exchange for reduced
administrative burdens and
performance-based
payments. Introduces new,
higher payments for practices
caring for complex,
chronically ill patients.
Promotes care for high need,
seriously ill population
(SIP) beneficiaries who lack
a primary care practitioner
and/or effective care
coordination.
Allows practices to participate
in both the PCF-General and
the SIP components of
Primary Care First
6. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 6
Participants Achieve Model Aims Through
Innovations in Their Care Delivery
PCF participants are incentivized to deliver evidence-based
interventions across 5 comprehensive primary care functions:
Access and Continuity
Care Management
Comprehensiveness
and Coordination
Planned Care and
Population Health
Comprehensive
Primary Care
Functions
Patient and Caregiver
Engagement
7. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation
Comprehensive Primary Care
Function
PCF Intervention
Access and Continuity
▪ Provide 24/7 access to a care team practitioner
with real-time access to the EHR
Care Management ▪ Provide risk-stratified care management
Comprehensiveness and
Coordination
▪ Integrate behavioral health care
▪ Assess and support patients’ psychosocial needs
Patient and Caregiver
Engagement
▪ Implement a regular process for patients and
caregivers to advise practice improvement
Planned Care and Population
Health
▪ Set goals and continuously improve upon key
outcome measures
7
Practices Have the Freedom to Innovate While
Implementing Core Functions of
Comprehensive Primary Care
8. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 8
The PCF Payment Model Option Emphasizes
Flexibility and Accountability
Promote patient access
to advanced primary care
both in and outside of the
office, especially for complex
chronic populations
Transition primary care
from fee-for-service payments to
value-driven, population-based
payments
PCF Payment Model Option Goals
Reward high-quality,
patient-focused care
that reduces preventable
hospitalizations
PCF Payments
Professional population-based payments
and flat primary care visit fees to help
practices improve access to care and transition
from FFS to population-based payments
Performance-based adjustments of
up to 50% of revenue and a 10%
downside, based on a single outcome
measure, with focused quality
measures
CMS Primary Cares Initiatives
9. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 9
Primary Care First Model Payments Include
Two Major Components
Total primary care payment Performance-based adjustment
Total Primary Care First Model payments
Opportunity for practices to increase revenue
by up to 50% of their Total Primary Care
Payment based on key performance measures,
including acute hospital utilization (AHU).
Professional
Population-Based
Payment
Flat Primary Care
Visit Fee
Regional adjustment
Continuous improvement
adjustment
1
2
10. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation
These payments allow practices to:
• Easily predict payments for face-to-face care
• Spend less time on billing and coding and
more time with patients
Payment for service in or outside the office,
adjusted for practices caring for higher risk
populations. This base rate is the same for all
patients within a practice.
10
Total Primary Care Payment Promotes
Flexibility in Care Delivery
Payment will be reduced through calculating a
“leakage adjustment” if beneficiaries seek primary
care services outside the practice.
Payment for in-person treatment that reduces
billing and revenue cycle burden.
$40.82
per face-to-face encounter
Payment amount does not include copayment or
geographic adjustment
Flat Primary Care Visit Fee
The Total Primary Care Payment is a hybrid payment that incentivizes advanced
primary care while compensating practices with higher-risk patients.
Population-Based Payment
Practice Risk Group
Payment
(per beneficiary per
month*)
Group 1: Average Hierarchical
Condition Category (HCC) <1.2
$28
Group 2: Average HCC 1.2-1.5 $45
Group 3: Average HCC 1.5-2.0 $100
Group 4: Average HCC >2.0 $175
* PBPM = Per Beneficiary Per Month
11. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 11
Performance-Based Payment Adjustments Are
Determined Based on a Multi-Step Process
In Year 1, adjustments are determined based on acute hospital utilization (AHU) alone.
In Years 2-5, adjustments are based on performance as described below.
Did the practice exceed the
Quality Gateway?
0% or -10%
Adjustment
Depends on year and/or AHU
performance;
Note: still eligible for continuous
improvement adjustment
Adjustments may be from -10% to 50% of total
primary care payment determined by comparing
performance to three different benchmarks:
No Yes
Regional adjustment
Continuous improvement
adjustment
1
2
Is practice performance above the 50th
percentile of the national Acute Hospital
Utilization (AHU) benchmark?
No Yes
12. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 12
Regional Adjustment Compares Acute
Hospital Utilization to a Regional Benchmark
Practices that exceed the 50th percentile AHU minimum benchmark will earn
a PBA based on how they perform relative to regional practices.
Regional adjustment1
Top 75% of the regional
reference group?
-10%
Adjustment
(still eligible for continuous
improvement bonus)
No Yes
AHU Regional Performance Level Regional Adjustment
Top 10 percentile of regional practices 34% of Total Primary Care Payment
11-20 percentile of regional practices 27% of Total Primary Care Payment
21-30 percentile of regional practices 20% of Total Primary Care Payment
31-40 percentile of regional practices 13% of Total Primary Care Payment
41-50 percentile of regional practices 6.5% of Total Primary Care Payment
51-75 percentile of regional practices 0% of Total Primary Care Payment
13. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 13
Practices Achieving Improvement Targets are
Eligible for a Continuous Improvement
Adjustment
Practices are also eligible for a continuous improvement (CI) bonus of up to 16% of the
possible 50% PBA amount if they achieve their improvement target. CMS may use statistical
approaches to account for random variations over time and promote reliability of improvement data.
Acute Hospital Utilization (AHU) Regional
Performance Level
Potential Improvement Bonus
Top 10 percentile of regional practices 16% of Total Primary Care Payment
11-20 percentile of regional practices 13% of Total Primary Care Payment
21-30 percentile of regional practices 10% of Total Primary Care Payment
31-40 percentile of regional practices 7% of Total Primary Care Payment
41-50 percentile of regional practices 3.5% of Total Primary Care Payment
51-75 percentile of regional practices 3.5% of Total Primary Care Payment
Practices performing in the bottom quartile of their
region
3.5% of Total Primary Care Payment
Continuous improvement adjustment2
14. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 14
The SIP Payment Model Option Increases
Seriously Ill Populations’ Access to Primary
Care
PCF incorporates the following unique aspects for practices electing to serve seriously
ill populations to increase access to high-quality, advanced primary care.
Eligibility and Beneficiary Attribution Payments
Practices demonstrating relevant
capabilities can opt in to be assigned
SIP patients or beneficiaries who lack a
primary care practitioner or care
coordination.
Medicare-enrolled clinicians who provide
hospice or palliative care can partner
with participating practitioners.
First 12 Months
▪ One-time payment for first visit with SIP
patient: $325 PBPM
▪ Monthly SIP payments for up to 12 months:
$275 PBPM
▪ Flat visit fees: $50
▪ Quality payment adjustment: up to $50
Payments for practices serving seriously ill
populations:
15. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 15
The Model’s Quality Strategy for Practice Risk
Groups 1-2 Includes a Focused Set of
Clinically Meaningful Measures
The following measures for Practice Risk Groups 1-2 will inform
performance-based adjustments and assessment of quality of care delivered.
Measure Type Measure Title Model Years
Utilization Measure for
Performance-Based
Adjustment Calculation
(Calculated Quarterly)
Acute Hospital Utilization (AHU) (HEDIS
measure)
Years 1-5
Quality Gateway
(Calculated Annually)
Patient Experience of Care Survey
(CAHPS® with supplemental items)
Year 2-5
Diabetes: Hemoglobin A1c (HbA1c) Poor
Control (>9%) (eCQM)
Controlling High Blood Pressure (eCQM)
Advance Care Plan (MIPS CQM measure)
Colorectal Cancer Screening (eCQM)
Practices in Risk Groups 3-4 and practices accepting SIP patients are evaluated on a
different set of quality measures— see the next slide for details.
16. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 16
Quality Measures for Practice Risk Groups 3-4
(and SIP) Account for Patients’ Clinical and
Supportive Needs
Practices in Risk Groups 3-4 and practices accepting SIP patients are
evaluated on a different set of quality measures than Risk Groups 1-2.
Measure Title Model Years
Advance Care Plan (MIPS CQM measure) (also
used for Practice Risk Groups 1-2)
Years 1-5
Total Per Capita Cost (MIPS claims measure) Years 1-5
CAHPS® (beneficiary survey)
Years 2-5
(but administered in Year 1)
24/7 Access to a Practitioner (beneficiary survey) Years 3-5
Days at Home (claims measure) Years 3-5
17. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 17
Primary Care First Innovates Data Sharing to
Inform Care Delivery
Participants get access to timely, actionable data to assess
performance relative to peers and drive care improvement.
Participants
Participants submit claims with
reduced documentation requirements.
PCF Data
Sharing
CMS provides data to feed into participants’
analytic tools and offer a view of their
performance compared to peers.
18. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 18
Practices Participating in the PCF-General
Payment Model Option Must Meet the
Following Eligibility Requirements
*Note: Practices participating only in the SIP option are not subject to these specific requirements.
✓ Include primary care practitioners (MD, DO, CNS, NP, PA) in good standing with CMS
✓ Provide health services to a minimum of 125 attributed Medicare beneficiaries*
✓ Have primary care services account for the predominant share (e.g., 70) of the practices’ collective
billing based on revenue*
✓ Demonstrate experience with value-based payment arrangements, such as shared savings,
performance-based incentive payments, and alternative to fee-for-service payments
✓ Use 2015 Edition Certified Electronic Health Record Technology (CEHRT), support data
exchange with other providers and health systems via Application Programming Interface (API),
and, if available, connect to their regional health information exchange (HIE)
✓ Attest via questions in the Practice Application to a limited set of advanced primary care delivery
capabilities, including 24/7 access to a practitioner or nurse call line, and empanelment of patients to
a primary care practitioner or care team
Practices participating in the PCF-General Payment Model Option must:
19. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 19
Practices Participating in the SIP Payment
Model Option Must Meet the Following
Eligibility Requirements
Practices receiving SIP-identified patients (identified based
on risk score) must:
✓ Include practitioners serving seriously ill populations (MD, DO, CNS, NP, PA) in good
standing with CMS
✓ Meet basic competencies to successfully manage complex patients and demonstrate
relevant clinical capabilities (e.g., interdisciplinary teams, comprehensive care, person-centered
care, family and caregiver engagement, 24/7 access to a practitioner or nurse call line)
✓ Have a network of providers in the community to meet patients’ long-term care needs for
those only participating in the SIP option
✓ Use 2015 Edition Certified Electronic Health Record Technology (CEHRT), support data
exchange with other providers and health systems via Application Programming Interface (API),
and, if available, connect to their regional health information exchange (HIE)*
*SIP-only practices can request a one-year implementation delay for the CEHRT requirement
20. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 20
CMS is Committed to Partnering with Aligned
Payers in Selected Regions
In PCF, CMS will encourage other payers to engage practices on similar
outcomes. CMS is soliciting interested payers starting in summer 2019.
Commercial Health
Insurers
Medicaid
Managed Care
Plans
Medicare Fee-
For-Service
Medicare
Advantage
Plans
State Medicaid
Agencies
PCF
Participants
An alternative to fee-for-service payments
Performance-based incentive opportunity
Practice- and participant-level data on cost,
utilization, and quality
Alignment on practice quality and performance
measures
Broadened support for seriously ill populations
Multi-payer alignment promotes:
21. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 21
Your Practice Can Experience Many Benefits
By Participating in Primary Care First
Enhanced access to actionable, timely data to inform your care
transformation and assess your performance relative to peers
Opportunities for practices that specialize in complex, chronic
patients and high need, seriously ill populations
Focus on single outcome measure that matters most to patients
Less administrative burden and more flexibility so providers can spend
more time with patients and deliver care based on patient needs
Potential to become a Qualifying APM Participant by practicing in an
Advanced Alternative Payment Model
Ability to increase revenue with performance-based payments that
reward participants for easily understood primary care outcomes
22. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 22
Primary Care First Will Launch in 2021
CMS Primary Cares Initiatives
Interested practices should review the Request for Applications (RFA) and can access the
Application Portal to complete an application.
Fall 2019
Practice applications open;
Payer statement of interest
posted
Winter 2020
Practice applications due
January 22, 2020; Payer
solicitation due March 13, 2020
Summer 2020
Participant
onboarding
Spring 2020
Practices and
payers selected
Practice application and
payer statement of interest
submission period begins
January 2021
Payment begins
23. CMS Primary Cares Initiatives Center for Medicare & Medicaid Innovation 23
Use the Following Resources to Learn More
About Primary Care First
For more information about Primary Care First and to stay up to date
on upcoming model events:
Visit
https://innovation.cms.gov/initiatives/primary-care-first-model-options/
Call
1-833-226-7278
Email
PrimaryCareApply@telligen.com
Follow
@CMSinnovates
Subscribe
Join the Primary Care First Listserv
Apply
Read the Request for Applications (RFA) here
Access the model application here