$10 Billion in CMS Funding Aimed at Healthcare Innovation

Published Online: August 15, 2014
Katie Sullivan, MA
The Affordable Care Act was implemented to change healthcare in the United States. In order to support that change, the government established the Center for Medicare and Medicaid Innovation (CMMI)—a sector of the government agency that aims to incentivize innovation among providers and payers.

States across the country have benefited from CMMI’s 10-year, $10 billion budget. In fact, it is the largest sum of funding ever devoted to healthcare transformation. The center intends to accelerate the development and testing of new payment and service delivery models at various healthcare organizations. The center’s supported innovation models are divided into 7 categories:
  • Accountable care
  • Bundled payments for care improvement
  • Primary care transformation,
  • Initiatives focused on the Medicaid and CHIP Population
  • Initiatives focused on the Medicare-Medicaid enrollees
  • Initiatives to speed the adoption of best practices; and
  • Initiatives to accelerate the development and testing of new payment and service delivery models
The group also encourages healthcare organizations and leaders to offer their own ideas about innovations. The center says it seeks input on innovative service delivery models, reimbursement models, and even technology.

“We look for ideas across the healthcare delivery continuum that achieve better care for patients, better health for our communities, and lower costs through improvement for our healthcare system,” the center said.

Still, not everyone is completely convinced that the group is fulfilling its purpose. “This is absolutely necessary” to try to change how care is bought and delivered, said Christopher Koller, president of the Milbank Memorial Fund, a nonprofit that works to improve medical decision making. “Is this the right way to do it? A whole bunch of experiments? Is the innovation center adequately resourced in an administrative way to do this? The jury is still out on this.”

CMMI programs focus on patient populations with expensive conditions including cancer, diabetes, and heart failure.  Groups who opt into CMMI innovation programs must demonstrate quality improvements within 6 months of enrollment. Center officials maintain that the group has an important role in improving patients’ health and controlling the rising costs of healthcare throughout the country.

 “We take the direction of Congress—that the goal was to test these models, to expand the successful ones, but also to terminate unsuccessful ones—very seriously,” said Patrick Conway, MD, who runs the center.

Around the Web

CMS is on a $10B Search for the Next Big Health Insurance Innovation — But Is It Going Anywhere? [MedCity News]

Innovation Models [CMS - CMMI]