Abstract
Dear Editor:
Just a few months ago, Diane Meier, MD, sent out an email asking members of the Center to Advance Palliative Care (CAPC) to submit applications to become innovation advisors for the Center for Medicare and Medicaid Innovation (CMMI).
CMMI's purpose is to test innovative health care service and payment delivery models and to reduce expenditures under Medicare, Medicaid, and Children's Health Insurance Program (CHIP), while preserving or enhancing the quality of care provided. The preference is for models that improve the coordination, quality, and efficiency of health care services. The CMMI has $10 billion of funding for FY2011 through FY2019. There is also a unique opportunity for the U.S. Secretary of Health and Human Services to expand successful models to the national level.
CMMI has a portfolio of programs called suites (see Table). These include ACO, Primary Care, Bundled Payment, Dual Eligible, Diffusion and Scale, Healthcare Innovation, Rapid Cycle Evaluation and Research, and Learning and Diffusion. The Innovation Advisor's Program is included in the Diffusion and Scale Suite. The goal of the program is to support CMMI's development and testing of new models of care delivery and payment. It is also hoped that the advisor's program will establish a network of experts in health care delivery system reform.
CMMI feels that delivery system transformation requires a five-part strategy. First, providers need to commit to change their business and clinical model. Then CMS and other payers need to provide alternative models to support the providers. Thirdly, the providers select their models and fourth, new models are explored together. Finally, new models need to be evaluated and spread.
CMMI is seeking innovative ideas that improve and facilitate coordinated care, promote comprehensive primary care, align and encourage market forces, increase efficiency and reduce variation, foster wellness and prevention, actively engage and activate patients, and support use of better information by providers and patients. A project's success will be measured by how well it improves a three-part aim of better health, better health care, and reduced costs.
Better health will be measured by individual and population metrics. Better health care will be measured by improved experience of care, safety, effectiveness, patient centeredness, timeliness, efficiency, and equity metrics. Reduced cost evaluation will look at the total cost of care through improvement in care delivery. It is felt that health care transformation will not occur until a large percent of providers understand and embrace the concepts of the three-part aim.
The Innovation Advisor's Program had over 900 applicants. Seventy-three individuals from 27 states were selected to be a part of the first cohort. It is expected that a total of 200 advisors will be selected. The advisors will refine, apply, and sustain key skill sets including operations research, systems analysis, population health, and health care finance. I took Dr Meier's suggestion and applied to the program. I am among the first cohort of advisor's chosen by CMMI.
The broad focus of the projects selected in the first cohort include IT and data management, 30-day reduction in hospital readmissions, in-hospital quality and process improvement, integrated care—both disease specific and broader, care transitions, pharmacy integration, in-home care, expanding navigator roles, and payment reform. I am encouraged to report that several of the projects selected have a palliative care focus.
I describe my project as a palliative care medical home model. I am part of a 900 multispecialty physician group practice in northern California. It is known that the majority of hospitals with over 300 beds have inpatient palliative care programs. Palliative care lacks a viable model to coordinate care both before and after an acute hospitalization. In my area, there are multiple unaffiliated hospitals, hospices, home health agencies, and nursing homes. The hospitals include both community-based and tertiary-care teaching hospitals. As patients become sicker they must traverse these silos of care and many times care coordination breaks down. My project seeks to coordinate care for these patients regardless of where they are physically located in the health care system and to communicate this to the patient's primary care team. This coordination includes advance care planning, symptom management, and care for existential issues. A multidisciplinary team delivers the care. We hope to capture metrics to prove the three-part aim of better health, better health care, and reduced cost. I am honored to be a part of the Innovation Advisor's Program.