1. CMS Innovation Center New Direction Request for Information
Steven Farmer, MD, PhD
Senior Advisor and Medical Officer
CMS Innovation Center
Centers for Medicare & Medicaid Services

2. Disclaimer
This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.
This presentation is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Medicare policy changes frequently, and links to the source documents have been provided within the document for your reference
The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.

3. CenterS for medicare & Medicaid services
5/4/2017
CenterS for medicare & Medicaid services

4. Size and Scope of CMS Responsibilities
6/25/2018
Size and Scope of CMS Responsibilities
CMS is the largest purchaser of health care in the world
Combined, Medicare and Medicaid pay approximately one-third of national health expenditures (approx $800B)
The Medicare program alone pays out over $1.5 B in benefit payments per day
CMS programs currently provide health care coverage to 1 in every 3 Americans

5. Department-Wide Strategy
a health care system that results in better accessibility, quality, affordability, empowerment, and innovation
Less bureaucratic and complex
Reduces burden for clinicians, providers and beneficiaries

6. Innovative Approaches Operational Excellence
Putting People First
Empowered Providers
Beneficiaries have the information they need to make informed choices, and are in charge of their healthcare
State Flexibility
States can design programs to meet unique challenges
Innovative Approaches
Quality, accessibility, affordability, and data drive innovation
Technology prevents fraud, waste, and abuse
Customer Experience
Internal and external stakeholders have an improved experience
Operational Excellence
Continuous improvement drives sustained change

7. 5/4/2017
CMS Innovation center

8. The CMS Innovation Center was created to develop, test, and implement new payment and delivery models
“The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care furnished to individuals under such titles”
Three scenarios for success*:
Quality improves; cost neutral
Quality neutral; cost reduced
Quality improves; cost reduced (best case)
*If a model meets one of these three criteria and other statutory prerequisites, the statute allows the Secretary to expand the duration and scope of a model through rulemaking

9. Transformation of Health Care at the Front Line
At least six components:
Quality measurement
Aligned payment incentives
Comparative effectiveness and evidence available
Health information technology
Quality improvement collaboratives and learning networks
Training of clinicians and multi-disciplinary teams
Source: P.H. Conway and Clancy C. Transformation of Health Care at the Front Line. JAMA 2009 Feb 18; 301(7): 763-5

10. CMS Innovation Center Portfolio*
The Innovation Center portfolio aligns with delivery system reform focus areas
Focus Areas
CMS Innovation Center Portfolio*
Test and expand alternative payment models
Pay Providers
Accountable Care
Bundled payment models
ACO Investment Model
Bundled Payment for Care Improvement Models 1-4
Pioneer ACO Model
Oncology Care Model
Medicare Shared Savings Program (housed in Center for Medicare)
Comprehensive Care for Joint Replacement
Initiatives Focused on the Medicaid
Comprehensive ERSD Care Initiative
Medicaid Incentives for Prevention of Chronic Diseases
Next Generation ACO
Strong Start Initiative
Primary Care Transformation
Medicaid Innovation Accelerator Program
Comprehensive Primary Care Initiative (CPC) & CPC+
Dual Eligible (Medicare-Medicaid Enrollees)
Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration
Financial Alignment Initiative
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents
Independence at Home Demonstration
Graduate Nurse Education Demonstration
Integrated ACO
Home Health Value Based Purchasing
Medicare Advantage (Part C) and Part D
Medicare Care Choices
Medicare Advantage Value-Based Insurance Design Model
Frontier Community Health Integration Project
Medicare Diabetes Prevention Program
Part D Enhanced Medication Therapy Management
Deliver Care
Support providers and states to improve the delivery of care
Learning and Diffusion
State Innovation Models Initiative
Partnership for Patients
SIM Round 1 & SIM Round 2
Transforming Clinical Practice
Maryland All-Payer Model
Pennsylvania Rural Health Model
Health Care Innovation Awards
Vermont All-Payer ACO Model
Accountable Health Communities
Million Hearts Cardiovascular Risk Reduction Model
Distribute Information
Increase information available for effective informed decision-making by consumers and providers
Information to providers in CMMI models
Shared decision-making
* Many Innovation Center programs test innovations across multiple focus areas

11. CMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state level
Sites where innovation models are being tested
Source: CMS Innovation Center website, February 2017

12. The CMS Innovation Center is undergoing a re-assessment
Reviewing existing models against new direction:
Adjustments to policy
Introduction of new features
Soliciting public feedback on new model concepts:
Exploring and refining concepts
Assessing interest

13. RFI Solicits Ideas on How to:
Promote patient centered care
Test market driven reforms
Empower beneficiaries as consumers
Provide price transparency
Increase choices and competition to drive quality
Reduce costs
Improve outcomes

14. Guiding Principles Choice and competition in the market:
Competition based on quality, outcomes, and cost
Provider choice and incentives:
Voluntary models
Reduce burdensome requirements and unnecessary regulations
Patient centered care:
Empower beneficiaries, families, and caregivers to take ownership of care

15. Guiding Principles Benefit design and price transparency
Transparent model design and evaluation
Small scale testing:
Smaller, more nimble models
Focus on payment interventions rather than specific tests or treatments

16. 5/4/2017
Focus Areas

17. Advanced Alternative Payment Models
Eligible clinicians who are Qualifying APM Participants (QPs) between 2019 and 2024:
Lump-sum incentive payment
Higher update of Physician Fee Schedule (PFS) after 2026
Not subject to Merit-based Incentive Payment System (MIPS) reporting, payment adjustments
The Innovation Center is exploring how to:
Increase number of QPs
Strategies to incent eligible clinicians
Capture appropriate data to drive model design

18. Physician Specialty Models
Improve availability of specialty models:
Independent physician practices
Chronic management models
Variations of the Oncology Care Model concept
Physician-Focused Payment Model Technical Advisory Committee (PTAC):
Growing number of submissions
Secretary may make recommendations to the Innovation Center

19. Consumer-Directed Care & Market Based Innovation Models
Consumer-directed models could empower beneficiaries to chose providers in market-driven healthcare system:
Encourage price and quality transparency
Public reporting
Promote consumerism and transparency:
Direct contracting with healthcare providers
Providers propose prices for bundled services
Bidding for bundled services
Preferred provider networks

20. Medicare Advantage (MA) Innovation
Provide MA plans with greater flexibility to innovate
Medicaid Advantage Value-Based Insurance Design (VBID):
Incentives to chose high-value services
Competitive bidding for beneficiaries:
Quality and cost

21. State-Based and Local Innovation
Partner with states to drive better outcomes:
State Innovation Models
Innovation Accelerator Program
Strong Start
Medicaid Incentives for Prevention of Chronic Disease
State models are customized to local needs:
Offer more local flexibility
Multi-payer reforms

22. Mental and Behavioral Health
Exploring models focused on:
Opioids / substance use disorder
Dementia
Improving mental healthcare provider participation in Medicare, Medicaid, and CHIP

23. Prescription Drug Models
Prescription drug models under-represented:
Part B, D, and Medicaid
Better align incentives, engage beneficiaries
Value based purchasing programs
Increase pricing competition

24. Program Integrity
Desire to balance program integrity with burden on patients and providers
Seeks input on:
Reducing fraud and abuse
Improving program integrity

25. 5/4/2017
Questions

26. Questions Comments on guiding principles
Model designs (structure, approach)
Options beyond FFS and MA for improving value
How can CMS better engage beneficiaries in model development
Payment waivers that CMS should consider
Other comments

27. Feedback
RFI solicits public feedback, not a commitment to pursue specific idea or approach
Draw responses from objective, empirical and actionable evidence
Your feedback will be carefully reviewed and considered

28. New Direction - CMS Innovation Center Request for Information (RFI)
The RFI seeks broad input related to a new direction for the CMS Innovation Center that will promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, and improve outcomes.
The administration plans to launch models in several focus areas:
Guiding Principles
Choice and competition in the marketplace
Provider choice and incentives
Patient-centered care
Benefit design and price transparency
Transparent model design and evaluation
Small scale testing
Expanded Opportunities for Participation in Advanced APMs
Consumer-Directed Care & Market-Based Innovation Models
Physician Specialty Models
Physician-Focused Payment Model Technical Advisory Committee (PTAC) Recommended Models
Prescription Drug Models
Medicare Advantage (MA) Innovation Models
State-Based and Local Innovation, including Medicaid-focused Models
Mental and Behavioral Health Models
Program Integrity
Submit feedback
& ideas @
innovation.cms.gov/initiatives/direction/ through November 20, 2017

29. Thank you