The new Center for Medicare and Medicaid Innovation, established by the recent healthcare reform legislation, must be "inclusive and flexible in developing and implementing payment initiatives" in order to improve healthcare delivery and reduce spending, according to a new article in Health Affairs.
In "The Center for Medicare and Medicaid: Innovation Will Be Central to Health Reform's Success," Commonwealth Fund researchers Stuart Guterman, Karen Davis, Kristof Stremikis, and Heather Drake present a series of recommendations for the CMI which, as described in the Affordable Care Act, is meant to develop innovative ways of providing and paying for healthcare that have the potential to reduce costs while preserving or enhancing healthcare quality.
The CMI, which will begin full operations as part of the Centers for Medicare and Medicaid Services (CMS) in 2011, will be responsible for developing at least 18 reform models specified in the new law, including: patient-centered medical homes, promotion of care coordination through salary-based payment, community-based health teams to support small-practice medical homes, use of health information technology to coordinate care for the chronically ill, and salary-based payment for physicians.
"Changing the way we pay for and provide healthcare to reward high-quality, efficient care is an essential step toward a high performance health system," said Commonwealth Fund President Karen Davis. "If health reform is to succeed in improving care and curbing spending, this new center must function like a research and development laboratory for healthcare delivery, designed to discover, support, and disseminate the best and most innovative ideas."
The authors recommend that the CMI:
- Adopt a nimble "innovation with evidence development" approach in which new programs are implemented and continued as long as they show they are improving quality and value, and achieving desired outcomes.
- Include among its pilots an array of healthcare payment models, with the foremost goal being that payments are tied to high quality, efficient care that is patient-centered.
- Include private sector payers and public health insurance programs including Medicare and Medicaid in pilot initiatives.
- Be open to payment reform approaches led by states or private sector entities, taking into account geographic differences in healthcare and the environments in which care is provided.
- Ensure transparency by developing explicit criteria for selecting new programs and their participants and putting in place a mechanism to inform policymakers about ongoing and planned projects.
- Guarantee there are systems in place to continuously monitor and identify pilots' successes and failures.
- Be a partner in the success of pilots, rather than a "hands-off" evaluator, providing regular feedback and technical assistance to pilot participants when needed.
- Share information and findings with the new Independent Payment Advisory Board, which will be up and running in 2014 and is tasked with reducing Medicare spending growth, to assure that its recommendations designed to control spending are based on the best available information about ongoing and promising initiatives.