1. Innovation and Risk: Transitioning Through Payment Reform Activities
Indiana Rural Health Association
17th Annual Rural Health Conference
June 10 – 11, 2014

2. Discussion Overview Payment Reform: A Market in Transition
Innovation Payment Models
Regulatory Environment & Other Market Influences

3. Payment Reform: A Market in Transition

4. True Reform Will Require Disruptive Innovation*
Simplifying
Technology
Low Cost Business Models
Value Network
Regulations &
Standards
That Facilitate
Change
* Source: “The Innovator’s Prescription” by Clayton M. Christensen

5. Supreme Court Examines Constitutionality
U.S. Supreme Court Ruling: June 28, 2012
Individual Mandate - Constitutional
Entire Affordable Care Act - Stands
Medicaid Expansion
-State Option

6. The Foundation: Value-Based Payment
Value Based Payment: “a reform initiative whereby health care providers will receive payment for service based on their performance or the potential outcomes of the service”
Tying payment to performance is perhaps the most significant aspect of health care reform.
The de facto definition of “value” in health care reform is the intersection of lower cost and improved quality.
Providers who can lower costs and deliver quality will be measured as “value-based providers”
Value
Lower Cost
Improved Quality

7. Innovation Payment Models

8. Where Payment Reform is Happening*
* Source: Americas Health Insurance Plans (AHIP) accessed via web on 9/3/13 at:
reform activity

9. Payment Reform Models Focus: Behavior-Intensive Diseases w/Deferred Consequences
Diseases with Immediate Consequences
Strong:
Immediate
Consequences
Myopia
Chronic Back Pain
Psoriasis
Infertility
Hypothyroidism
GERD
Crohn’s Disease
Allergies
Celiac Disease
Multiple Sclerosis
Ulcerative Colitis
Depression
Sickle Cell Anemia
Epilepsy
HIV
Type I Diabetes
Behavior dependent diseases
Motivation to Comply With Best Known Therapy
Technology Dependent Diseases
Parkinson
Asthma
Congestive Heart
Failure
Cystic Fibrosis
Crushing costs of caring for chronically ill are in this quadrant: diabetes, asthma, tobacco, obesity, CHF, affect tens of millions of people each.
Coronary Artery Disease
Type II Diabetes
Chronic Hepatitis B
Schizophrenia
Osteoporosis
Cerebrovascular Disease
Alzheimer’s
Hypertension
Weak:
Deferred
Consequences
Hyperlipidemia
Bipolar Disorder
Obesity
Diseases with deferred consequences
Addictions
Minimal
Extensive
Degree to Which Behavior Change is Required
Source: “The Innovator’s Prescription” by Clayton M. Christensen

10. Chronic Disease Burden on Medicare Spending*
Zero or 1 condition
Zero or 1
condition
2 or 3 conditions
4 to 5 conditions
2 or 3 conditions
Beneficiaries with chronic conditions are what drive Medicare spending. 14% of the Medicare population accounts for just under 50% of total Medicare spending. This population has 6 or more chronic conditions. Of the beneficiaries in the top 10% of Medicare spending nearly 50% had congestive heart failure compared to less than 15% of the overall Medicare population, and ischemic heart disease was twice as common. Nearly twice as many individuals in the top decile of Medicare spending had diabetes.
4 to 5 conditions
6 or more
conditions
6 or more
conditions
* Source: MedPAC March 2014 Report to Congress

11. CMS Defined Innovation Models *
Accountable Care
Medicare Shared Savings Program
Medicare Advanced Payment ACO
Pioneer ACO
Comprehensive ESRD Care Initiative (LI/App.)
Bundled Payment for Care Improvement
Models 1 through 4
Primary Care Transformation
Comprehensive Primary Care Initiative
FQHC Advance Primary Care Practice Demonstration
Graduate Nurse Education Demonstration
Independence at Home Demonstration
Multi-Payer Advanced Primary Care Practice
* Arising as a result of Affordable Care Act (ACA), and excluding programs in effect prior to ACA.

12. CMS Defined Innovation Models *
Medicaid & CHIP Initiatives
Emergency Psychiatric Demonstration
Incentives for Prevention of Chronic Diseases Model
Strong Start for Mothers & Newborns Initiative
Reduce Early Elective Deliveries
Enhanced Prenatal Care Models
Medicare-Medicaid Enrollees Initiatives
Financial Alignment Incentives
Reduce Avoidable Hospitalizations Among Nursing Facility Residents
Initiatives to Accelerate Testing & Development of New Models
Health Innovation Awards
State Innovation Models
Initiatives to Speed Adoption of New Models
Community Based Care Transitions Programs
Innovation Advisors Program
Million Hearts
Partnerships for Patients
* Arising as a result of Affordable Care Act (ACA), and excluding programs in effect prior to ACA.

13. ACOs Continue to Grow
On December 23rd CMS announced that 123 new organizations will join the Medicare ACO program effective January 1, 2014
ACO enrollment has evolved and continued to grow since it was launched in April 2012:
April 2012 initial: 27 organizations
July 2012: 89 additional organizations
January 2013: 106 additional organizations
December 2011: 32 Pioneer ACOs, w/~ 23 remaining
Total ACO participation
Over 360 organizations
More than 5.3 million beneficiaries
More than 50% of ACOs led by physician groups, with < 10,000 beneficiaries

14. ACO Results to Date * Pioneer ACO First Year Results:
Cost Reduction/Shared Savings:
Cost growth rate for 669,000 beneficiaries .3% vs. .8%
13 participants generated gross savings of $87.6 million
2 participants generated losses of approximately $4 million
Quality Metrics
100% successfully reported quality measures
Overall performed better for all 15 clinical quality measures
25 of 32 generated lower risk-adjusted readmissions rates
Median rate for blood pressure control for beneficiaries with diabetes was 69% vs. 55%
Median rate for LDL cholesterol control for patients with diabetes was 57% vs. 48%
CMS expects MSSP results later in year
* Source: CMS “Pioneer Accountable Care Organizations succeed in improving care, lowering costs” July 16, 2013

15. Medicare Bundled Payments for Care: Medicare’s Largest Payment Innovation Program
BPCI1 Participation by State
More than 450 Providers Participating in BPCI1
Source: The Advisory Board

16. BCPI Participants Favoring Longer Episodes
Participation by Model Type
Hospital Inpatient Services
Hospital and Physician Inpatient and
Post-Discharge Services
Hospital and Physician Inpatient Services
Source: Centers for Medicare and Medicaid Services; Health Care Advisory Board interviews and analysis.

17. CMS Bundled Payments Initiatives: What is Being Bundled?
BPC Initiative initially invited participants to propose their own bundles, but in September 2012 CMMI changed it’s course and provided a limited set of standardized bundles providers could choose to pursue. In the end 48 different bundles were created from which participants could choose from – including selection of multiple bundles, which just over 50% of the participants did elect multiple bundles.
Of the top 10 bundles selected by participants, 7 of the 10 were surgical and 3 were medical conditions. Key risks associated with entering into a bundled payment contract are: Financial Risks: success will mandate reducing direct costs involved in providing care; Design Risk: success will mandate effective understanding of historical data to assist in construction of bundled activity and establishing effective gainsharing models to ensure physician engagement; Operational Risk: success will mandate effective standardization of care processes, coordination of care across all sites of care, and ensuring that all providers and patients are effectively engaged in care process.
Source: The Advisory Board: “What are BPCI participants bundling?” by Rob Lazerow dated February 1, 2013

18. Bundled Payments: Understanding Bundle Characteristics
Bundle Risk: Approximately 51% of total bundle costs occurred post-discharge!
CONFIDENTIAL: Subject to CMS Data Use Agreement #22626

19. Bundled Payments: The Post Acute Care Path and Impact on Bundle
Acute Stay
Discharge
CONFIDENTIAL: Subject to CMS Data Use Agreement #22626

20. Commercial Insurance BPI Activity: Large Employers
Cardiovascular & Spine Services Bundles
Payer: Walmart
Six Participating Providers:
Virginia Mason Medical Center, Seattle, WA
Mayo Clinic, Scottsdale, AZ , Rochester, MN & Jacksonville, FL
Scott & White Memorial Hospital, Temple, TX
Mercy Hospital, Springfield, MO
Cleveland Clinic, Cleveland, OH
Geisinger, Danville, PA
Description: Beginning January million employees eligible for consultation and care for certain cardiac & Spine procedures at no additional cost. Walmart will cover cost of travel, lodging, and food for patient and one caregiver.
Payer: PepsiCo
Participating Providers: John Hopkins, Baltimore, MD
Description: Starting 12/11 began waiving deductibles & co-insurance for employees who receive cardiac and complex joint replacement surgery at John Hopkins.
Payer: Lowes
Participating Providers: Cleveland Clinic, Cleveland, OH
Description: Contract for heart surgery program; will waive $500 deductible, out-of-pocket costs, airfare, hotel and living expenses.
Source: The Advisory Board “Commercial Bundled Payment Tracker” accessed via web on 4/12/13 at:

21. CMS Primary Care Transformation
Comprehensive Primary Care Initiative
Multi-payer initiative fostering collaboration between public and private health care payers.
497 primary care practices covering 7 states
Includes 2,347 providers serving an estimated 315,000 Medicare Beneficiaries
Independence at Home Demonstration
Tests the effectiveness of delivering comprehensive primary care services to Medicare beneficiaries with multiple chronic conditions at home.
Providers who succeed in reducing costs and meeting designated quality measures will receive an incentive payment.
Participants announced in April 2012 and include 15 different practices in 12 different states
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

22. CMS Primary Care Transformation
Multi-Payer Advanced Primary Care Practice
CMS participating in 8 states with multi-payer reform initiatives already being conducted in states.
Demonstration focuses in on if advanced primary care practice will reduce unjustified utilization and expenditures, improve safety, effectiveness and timeliness and efficiency of health care services.
Monthly care management fee is paid to cover care coordination, improved access, patient education, and other services to support chronically ill patients.
FQHC Advanced Primary Care Practice
A three-year demonstration program designed to evaluate the effect of advanced primary care practice model (commonly referred to PCMH) in improving care, promoting health, and reducing cost of care to Medicare beneficiaries served by FQHCs.
493 participating FQHCs will be paid a monthly care management fee of $6.00 (paid quarterly) per eligible beneficiary attributed to their practice.
Fee is in addition to the usual all-inclusive payment rate currently received.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

23. Patient Centered Medical Home – Demonstration Project Overview *
Project Objectives:
Identify and eliminate “gaps” in care
Reduction of health risk factors and enhancement of quality of life
Focused Clinical Conditions:
Asthma
Coronary Artery Disease
Hyperlipidemia
Hypertension
Adult/Adolescent/Childhood Immunizations
COPD
Diabetes
Anxiety/Depression
Breast/Cervical/Colorectal Cancer Screenings
Vital & Others
* Source: BCBSMT Presentation at MT HFMA on PCMH Demonstration Project Results Fall, 2011

24. Patient Centered Medical Home: Demonstration Project Incentive Plan*
Structure Incentives Based on Outcomes
Participation Amount
Quality Outcome Amount
Patient Satisfaction
TCOC Amount
Incentive s for Both Improving & Achieving Targets
Additional Payment Incentives
$200 PMPY for Care Management of Chronic Conditions
$100 PMPY for Care Management of Preventive Conditions
Potential Savings
Reduced ER visits
Preventable Admissions & Re-Admissions
Improved Health Status
Increased Productivity, Employee Morale & Reduced Absenteeism
* Source: BCBSMT Presentation at MT HFMA on PCMH Demonstration Project Results Fall, 2011

25. Patient Centered Medical Home: Demonstration Project Outcomes*

26. State Innovation Model Initiatives
Provides up to $300 million to support the development and testing of state-based delivery system transformation models for multi-payer payment and health care delivery system.

27. Regulatory Environment & Other Market Influences

28. Influencers of Medicare Reimbursement
American Taxpayer
Relief Act
January 2013
Patient Protection & Affordable Care Act (PPACA)
March 2010
MedPAC & OIG
2013 Reports
“Payment equalization across sites of service”
Elimination of CAH designation for 849 of 1,329 CAHs
President Obama’s September 2011 budget
CAH swingbed reimbursement vs. skilled nursing facilities
Rural Health Clinic (RHC) designation and rules compliance
New formula for DSH payments.
Established requirements for pay-for-performance initiatives
Grants CMS authority to recoup “excess payments”in “exchange” for temporary SGR patch
Bipartisan Budget Act
of 2013
Extended provisions of ATRA, including SGR, through 3/31/14
Protecting Access to Medicare Act of 2014
Extends provisions of ATRA for 1 year
CMS Annual Updates
ACA implementation
Value-Based-Payment
Readmissions
DSH Implementation

29. MedPAC Pushing Equalization Payment Pressures: “Good Ole Days” At Risk
“Last year we made a recommendation to equalize payment rates for office visits provided in hospital outpatient departments and physician offices. We will continue to analyze opportunities for applying this principle to other services and sectors, such as sectors that provide post-acute care.”
MedPAC 2013
Report to Congress
“Medicare often pays different amounts for similar services across settings. Basing the payment rate on the rate in the most efficient clinically appropriate setting would save money for Medicare… We extend that principle to specific services that meet the Commission’s criteria….”
MedPAC 2014
Report to Congress

30. MedPAC Payment Equalization Recommendations
Identified 5 criteria for services that are “good candidates”
Frequently (> 50%) performed in physicians office
Minimal packaging differences across payment systems
Infrequently provided in ED
Severity no greater in HOPD then freestanding offices
Do not have a 90-day global surgical code
Broke 450 APCs into two groups based on service category:
Group 1: 66 APCs
Characteristics: No emergency standby required; no extra costs associated with complexity; no additional overhead
Group 2: 42 APCs
Characteristics: Met 4 of the 5 above characteristics
Okay to exceed PFS rate, but only equal to cost of additional packaging
Estimated reductions of $1.1B
LTCH Non-Chronic Critical Payment Rate
Reduced from ~ $40,000/ case to ~ $12,000/case (similar to IP PPS)
Shift differential, ~ $2B, to IP PPS to increase outlier reimbursement for CCI patients

31. Transitioning to a New Market Place *
Indiana Marketplace **
Potential Size: 525,000
Completed Applications: 229,815
Enrollment: 132,423
Estimate of Uninsured Eligible for Medicaid/CHIP: 94,495
Assistance Eligible: 155,961
* Source: State Reforum an online network for health reform implementation at
** Source: Department of HHS; “Health Insurance Marketplace: Summary of Enrollment for the Initial Annual Open Enrollment Period” 10/1/13-4/19/14.

32. Trading Price for Volume on the Public Exchanges
Expect Lower Provider Payment Rates, Less Patient Choice
Anticipated Provider Reimbursement Rates for Exchange Plans
Aetna’s Planned Reduction in Exchange Network Size
25%-50% reduction in exchange network size, compared to networks for typical commercial products
WellPoint Inc.
Between Medicare and Medicaid rates
Catholic Health Initiatives Modest discounts from commercial rates
Millern Medical Center1
20% below commercial rates
Meyers Health1
10% above Medicare rates
Case in Brief: Aetna Inc.
Health insurer planning to sell narrow network exchange products in 14 states
Searching for providers agreeing to lower rates in narrow network products
Plans for rates to fall closer to Medicare than commercial reimbursement
Tenet Healthcare Up to 10% below commercial rates
Meriwether Hospital1
5% below commercial rates
Source: Mathews AW and Kamp J, “Another Big Step in Reshaping HealthCare,” Wall Street Journal, February 28, 2013, available at: Hancock J, “Aetna Cuts Predictions for Obamacare Enrollment,” Kaiser Health News, April 30, 2013, available at: Health Care Advisory Board interviews and analysis.
Pseudonym.

33. Health Insurance Coverage Patient Characteristics
Growth in Spending Will Dictate Risk: Factors Influencing Spending Growth*
Technology
Pricing Level & Growth
Market Prominence
Health Insurance Coverage
Patient Characteristics
Demographics
Source: MedPAC Report to Congress, March 2014

34. Will Access to Coverage Kick-Start Spending Growth?
Health care spending rose at fastest rate in 10 years in 4Q of 2013 at 5.6% **
Hospital revenue grew by $8 billion, despite 1% decrease in IP days
Reasons behind the increase:
Trend of shifting > out of pocket to insured leveling off
Upward pressures on costs, such as high-tech treatments, are remerging
Since 2011 unemployment has dropped from 8.5% to 6.7%, adding 2.6 million jobs
“The Centers for Medicare and Medicaid Services expects health spending to rise 6.1% this year……as 11 million people gain health insurance.”**
** Source: USA Today “Health care spending growth hits 10-year high”

35. Emerging Risk in Commercial Contracting
Background
Insurer is implementing a new payment system and provided estimated impact of conversion.
Estimated impact of the change was a reduction of net revenues of about $831,000 (14%)
However, as claims are being processed the impact is greater than initially estimated
Application of LCC rule further reduces net revenues by $954,000 (-16%)
Revised Estimated Impact
Baseline Conversion Impact ($831,000)
Additional Reduction Due to Application of Claim Level LCC ($954,000)
TOTAL NET REVENUE IMPACT OF NEW CONTRACT ($1,785,000)
Overall % Reduction in Payor Revenue %

36. Emerging Risk in Commercial Contracting (cont’d)
Overall Payment Rate (2012 Pricing)
What it used to be under the old contract
Initial estimate based on analysis of new contract
Actual rate from paying at lower of allowable or charges at a claim level (LCC)

37. Introduction of New Competion: Walmart Eying the Health Care Industry
Moving Beyond Basic Retail Clinics
Potential Evolution of Health Care Products
Basic Retail Clinic
Full Primary Care
Health Insurance Exchange
Scope of Services ”
“That’s where we’re going now: full primary care services in five to seven years.”
Vice President
Health and Wellness Payer Relations
33%
Estimated portion of the US population that visits Walmart every week
4,600+
Number of Walmart stores in the United States
Median distance between a residence and Walmart
4.2 miles
Source: The Advisory Board Holmes TJ, “The Diffusion of Wal-Mart and Economics of Density,” May, 2006; Zimmerman A and Hudson K, “Managing Wal-Mart: How U.S.-Store Chief Hopes to Fix Wal-Mart,” The Wall Street Journal, April 17, 2006, available at: Aboraya A, “Wal-Mart Plans to Offer Primary Care in 5-7 Years,” Orlando Business Journal, January 11, 2013, available at: Aboraya A, “Exclusive: Wal-Mart Exploring Private Health Insurance Exchange for Small Biz,” Orlando Business Journal, January 11, 2013, available at: Health Care Advisory Board interviews and analysis. 37

38. Introduction of New Competion: Beyond Walmart
Walgreens Aims to Become the Premier Health Destination
2013: Launches three ACOs; begins diagnosing and managing chronic disease
2009: Launches flu vaccine campaign
Simple Acute Services
Vaccinations and Physicals
Chronic Disease Monitoring
Chronic Disease Diagnosis and Management
2007: Acquires Take Care Health Systems
2012: Offers three new chronic disease tests
Case in Brief: Walgreen Co.
Not Just a Drugstore ”
Largest drug retail chain in the United States, with 372 Take Care Clinics
In April 2013, became first retail clinic to offer diagnosis and treatment of chronic diseases
“Our vision is to become ‘My Walgreens’ for everyone in America by transforming the traditional drugstore into a health and daily living destination...”
Walgreen Co. Overview
Source: The Advisory Board Japsen B, “How Flu Shorts Became Big Sales Booster for Walgreen, CVS,” Forbes, February 8, 2013, available at: “Take Care Clinics at Select Walgreens Expand Service Offerings,” Reuters, May 31, 2012, available at: Murphy T, “Drugstore Clinics Expand Care into Chronic Illness,” The Salt Lake Tribune, April 4, 2013, available at: Walgreens, “Company Overview,” available at: Health Care Advisory Board interviews and analysis. 38

39. 2014 Market Transitions to Monitor
Transitioning commercial contracting
More “stiff arming” especially for smaller providers
Exchange related impacts
Glitch continuation?
Reimbursement implications
“Surprise” narrow networks ?
Increased demand for medical services
Reprieves from mandates – how long will they last?
Consumer impact – choice & out-of-pocket costs
Escalation in ruthless competition
Formation of narrow networks impacting market share
On-going provider operational challenges
Revenue cycle issues
Profitability continues to be squeezed
Charge capture issues

40. Parting Comments
Health care payment system is being driven to “value based” payments
The transition in large part is market driven
Many of the initiatives take aim at improving management, access, and quality of care provided to patients with chronic conditions
Short-term outcomes show promise, but it will be years before we understand the true benefit of this transition
Outside of new innovation models, some of payment reform activity is not all that innovative
Transition market is creating unique competition challenges

41. Questions/Comments THANK YOU! Rob Schile, CPA MP Health Systems
For information on health care reform, go to
CliftonLarsonAllen’s Health Care Reform Center at:

42. Appendix: Indiana Payment Innovation Initiatives

43. Indiana Innovation Activity ACO Participation
Advanced Payment ACO
American Health Network of Ohio Care Organization, LLC (Indianapolis)
Pioneer ACO
Franciscan Alliance (Indianapolis)
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

44. Indiana Innovation Activity BPCI Model 2 Participation
Bone & Joint Specialists, P.C. (Merrillville)
Central Indiana Orthopedics (Muncie)
Clark Memorial Hospital (Jeffersonville)
Community Hospital of Anderson and Madison County, Inc. (Anderson)
Community Hospital South, Inc. (Indianapolis)
Community Hospitals of Indiana, Inc. (Indianapolis)
Community Physicians of Indiana, Inc. (Indianapolis)
Heart Group, PC (Evansville)
Indiana Heart Hospital, LLC (Indianapolis)
Indiana Hospitalists PC (Richmond)
Indianapolis Osteopathic Hospital, Inc. (Indianapolis)
Orthopaedics Indianapolis, Inc. (Indianapolis)
Premier Healthcare, Llc (Bloomington)
Providence Medical Group Llc (Terre Haute)
Saint Joseph Regional Medical Center – Mishawaka Campus (Mishawaka)
Saint Joseph Regional Medical Center – South Bend Campus (Mishawaka)
St. Joseph Regional Medical Center – Plymouth Campus)
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

45. Indiana Innovation Activity BPCI Model 3 Participation
Amedisys Home Health of Jeffersonville (Jeffersonville)
Bone & Joint Specialists, P.C. (Merrillville)
Chicagoland Christian Village, Inc. (Crown Point)
Community Physicians of Indiana, Inc. (Indianapolis)
Covenant Care Indiana Inc. University Park Health and Rehabilitation Center (Fort Wayne)
Decatur Township Center (Indianapolis)
Heart Group PC (Evansville)
Home Health Care Solutions (Avon)
Hoosier Christian Village, Inc. (Indianapolis)
Indiana Hospitalists PC (Richmond)
Indianapolis Osteopathic Hospital Inc. (Indianapolis)
Lakeland Skilled Nursing & Rehab (Angola)
McCormick’s Creek Rehabilitation & Skilled Nursing Facility (Spencer)
Miller’s Merry Manor (31 locations)
New Haven Care Center (New Haven)
Norwood Health & Rehabilitation Center (Huntington)
Oak Health Care Investors, Inc. (Butler)
Orthopaedics Indianapolis, Inc. (Indianapolis)
Premier Healthcare Llc (Bloomington)
Providence Medical Group (Terre Haute)
Pyramid Point Post-Acute & Rehab Center (Indianapolis)
Waldron Health & Rehab Center (Waldron)
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

46. Indiana Innovation Activity FQHC Demonstration
Indiana Participants
Cass County Community Health Center (Logansport, IN)
Community Health Center of Jackson County (Seymour, IN)
HealthLinc, Inc. (Valparaiso, IN)
Indiana Health Centers, Inc.
South Bend, IN
Kokomo, IN
Vermillion-Parke Community Health Center (Clinton, IN)
3 year demonstration
Help Medicare beneficiaries manage chronic conditions and provide coordinated care
Receive $6 monthly care management fee for each eligible Medicare beneficiary
Achieve Level 3 patient-centered medical home recognition
Source: and
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

47. Health Care Innovation Awards:
CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity
Health Care Innovation Awards:
Trustees of Indiana University:
Project Title: “Dissemination of The Aging Brain Care Program” (ABC)
Geographic Reach: Indiana
Funding Amount: $7.8 Million
Est. 3 Year Savings: $15.7 Million
Project Summary:
Reduce behavioral and psychological symptoms of dementia, improve patients’ or informal caregivers’ satisfaction and access to care, improve the quality of dementia and depression care, and reduce acute care utilization.
Expansion of The Aging Brain Care (ABC) program which has been in effect for 2 years serving > 200 patients.
ABC will expand to more than 2,000 Medicare & Medicaid beneficiaries with dementia and late-life depression to accomplish the stated project goals.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

48. Health Care Innovation Awards:
CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity
Health Care Innovation Awards:
TransforMed
Geographic Reach: AL, CT, FL, GA, IN, KS, KT, MD, MA, MI, MS, NA, NC, OK, SD, WV
Funding Amount: $20.7M
Est. 3 Year Savings: $52.8M
Project Summary:
Primary care redesign project across 15 communities to support care coordination among Patient-Centered Medical Homes (PCMH), specialty practices, and hospitals, creating “medical neighborhoods”.
Project will utilize sophisticated data analytics to identify high risk patients and coordinate care across the medical neighborhood while driving PCMH transformation in primary care practices in each community.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

49. Health Care Innovation Awards:
CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity
Health Care Innovation Awards:
Nat’l Council of YMCA of USA
Geographic Reach: AZ, DL, FL, IN, MN, NY, OH, TX
Funding Amount: $11.9M
Est. 3 Year Savings: $4.3M
Project Summary:
In partnership with other non-profit organizations, will expand YMCA’s Diabetes Prevention Program to prediabetic Medicare beneficiaries in 17 communities.
Deliver community-based diabetes prevention through a nationally recognized diabetes prevention lifestyle change program, coordinated and taught by trained YMCA Lifestyle Coaches.
Goal is to prevent the progression of prediabetes to diabetes, which will improve health and decrease costs associated with complications of diabetes, hypercholesterolemia and hypertension.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

50. Health Care Innovation Awards:
CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity
Health Care Innovation Awards:
Feinstein Institute for Medical Research
Geographic Reach: FL, IN, MI, MO, NH, NM, NY, OR
Funding Amount: $9.4M
Est. 3 Year Savings: $10.1M
Project Summary:
Develop a workforce capable of delivering effective treatments, using newly available technologies to at-risk, high-cost patients with schizophrenia
Provide training and education to patients and caregivers about pharmacologic management, cognitive behavior therapy, and web-based/home-based monitoring tools for their conditions intended to improve patients quality of life and lower cost by reducing hospitalizations.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)

51. Indiana Innovation Activity CCMI Initiatives to Speed Adoption of New Models
Community Based Care Transitions Program
Section 3026 of ACA
Test models for improving care transition from hospital to other settings and reducing readmissions for high risk Medicare beneficiaries
102 total participants
Indiana Participants:
Aging & In-Home Services of Northeast Indiana (Fort Wayne, IN)
LifeSpan Resources, Inc. (New Albany, IN)
Source: The Centers for Medicare & Medicaid Innovation (CMMI)