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The Voice of John Nimsky
For those of you who applied for the Innovations Awards Program Round One and were denied, or for those of you who didn’t apply, CMS/CMMI is providing you with another opportunity to do so. The program is open to virtually any health organization (the exception is that CMS will not entertain proposals that are primarily focused on inpatient hospital based programs) interested in proposing innovative service delivery and payment models focused on the Medicare, Medicaid and Children’s Health Insurance program (Chips) eligible populations. CMS will fund those proposals that have the greatest potential for driving health care delivery transformation and innovative pricing methodologies. There is approximately $900 million in available funding.
Anyone who has paid attention knows that since 2011 more than 200 Medicare ACO’s have been operationalized. If you add in commercial ACO’s, the number is closer to 400.
Thirty-two Pioneer ACOs sent a correspondence to CMMI in late February, suggesting that they would exit the Pioneer ACO program if CMS did not accept their recommendations for changes to the quality measures employed to determine pay for performance in the Pioneer program. As a group, the Pioneer ACOs suggested to CMMI that because of their collective experience with performance based contracts and performance reporting on quality measures, they — not CMMI – know what works and what doesn’t when it comes to benchmarking quality to reimbursment.
I am old enough to remember cast iron automobile engines, massive, performance driven by basics such as carburators, distributors and spark plugs. No computer assists, no electronic fuel injection and no computer to monitor and identify performance problems. If the engine ran rough, we adjusted fuel and air mixture.Today’s engines are smaller, and have more software/technology embedded than the first and second generation desktop computers.
The June 18th blog by my colleague and friend William MacBain posed a valid question when he asked whether Medicare ACO’s are a revolution in healthcare or a side show. My view–it’s that and more. To the point that Medicare ACO’s will probably have only a minor impact on overall Medicare expenditures, I totally agree but would argue that significantly reducing Medicare expenses is not the overriding goal of the CMS sponsored shared savings program. I believe the overriding goal is to stimulate provider change in how healhcare is priced, delivered and made accessible to those who need it.