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Medicare Initiatives Authorized by The Affordable Care Act Nancy B. O’Connor Regional Administrator October 25, 2012 Richmond, VA.

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Presentation on theme: "Medicare Initiatives Authorized by The Affordable Care Act Nancy B. O’Connor Regional Administrator October 25, 2012 Richmond, VA."— Presentation transcript:

1 Medicare Initiatives Authorized by The Affordable Care Act Nancy B. O’Connor Regional Administrator October 25, 2012 Richmond, VA

2 Topics for Today CMS Background The case for patient-centered care The ACA-arsenal of health home options – MAPCP – CPCI – Independence at Home – Medicaid Health Home Accountable Care Organizations

3 About CMS Mission CMS is a constructive force and a trustworthy partner for the continual improvement of health and health care for all Americans. Largest health insurer in the country Over 100 million covered lives Over 1 million Medicare physicians 31 Medicare contractors Medicare/Medicaid/CHIP=$937 billion Top Priorities Keep the trains running Implement the Affordable Care Act Lead the improvement of health care in America New logo!

4 CMS’ Ten Regional Offices

5 Unsustainable – Escalating Costs – Excessive Services ACA lays the foundation for transformation – Provide better care – Promote better health – Lower costs The State of Health Care

6 Incentives for Delivering Integrated Primary Care – Multi-payer advanced primary care demonstration – Comprehensive Primary Care Initiative – Independence at Home – Medicaid Health Home Accountable Care Organizations – Medicare Shared Savings Program (MSSP – Pioneer – Advanced Payment Integrating Care Delivery

7 Multi-payer Advanced Primary Care Practice Model (MAPCP) Medicare will participate in existing State multi- payer health reform initiatives that currently include participation from both Medicaid and private health plans. The demonstration program will pay a monthly care management fee for beneficiaries receiving primary care from APC practices Eight states selected to participate By end of year 3, up to 1200 practices caring for ~900,000 beneficiaries 7

8 A major barrier to transformation in practice is transformation in payment Will test two models simultaneously: Practice Redesign Provision of core primary care functions Better use of data Payment Redesign PBPM care management fee Shared Savings opportunity Comprehensive Primary Care Initiative 8

9 Additional Health Home Models Independence at Home – A payment incentive and service delivery model utilizing physician and nurse practitioner teams – Reduce preventable hospitalizations, readmissions, and ER visits – Improve health outcomes, and care efficiency Medicaid Health Home – Option for all states – very flexible – Enhanced financial resources 9

10 ACO Models Pioneer Model – Designed for organizations well on their way to changing their care delivery/business models Advanced Payment Model – Gives certain ACOs access to up front shared savings Medicare Shared Savings Program – Facilitate coordination and cooperation among providers 10

11 Lessons Learned Getting to 5,000 assigned members Coordination takes time Physician champion are key to success Reliable data partner/IT infrastructure for analysis ACO management can drive provider conversation 11

12 Questions?


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