The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Our Innovation Models are organized into seven categories.
Category Descriptions
Categories
- Accountable Care
Accountable Care Organizations and similar care models are designed to incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.
- Bundled Payments for Care Improvement
Medicare currently makes separate payments to various providers for the services they furnish to the same beneficiary for a single illness or course of treatment (an episode of care). Offering these providers a single, bundled payment for an episode of care makes them jointly accountable for the patient’ care. It also allows providers to achieve savings based on effectively managing resources as they provide treatment to the beneficiary throughout the episode.
- Primary Care Transformation
Primary care providers are a key point of contact for patients’health care needs. Strengthening and increasing access to primary care is critical to promoting health and reducing overall health care costs. Advanced primary care practices –also called “edical homes”–utilize a team-based approach, while emphasizing prevention, health information technology, care coordination, and shared decision making among patients and their providers.
- Initiatives Focused on the Medicaid and CHIP Population
Medicaid and the Children’ Health Insurance Program (CHIP) are administered by the states but are jointly funded by the federal government and states. Initiatives in this category are administered by the participating states.
- Initiatives Focused on Medicare-Medicaid Enrollees
The Medicare and Medicaid programs were designed with distinct purposes. Individuals enrolled in both Medicare and Medicaid (the “ual eligibles” account for a disproportionate share of the programs’expenditures. A fully integrated, person-centered system of care that ensures that all their needs are met could better serve this population in a high quality, cost effective manner.
- Initiatives to Speed the Adoption of Best Practices
Recent studies indicate that it takes nearly 17 years on average before best practices - backed by research - are incorporated into widespread clinical practice—nd even then the application of the knowledge is very uneven. The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption.
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
Many innovations necessary to improve the health care system will come from local communities and health care leaders from across the entire country. By partnering with these local and regional stakeholders, CMS can help accelerate the testing of models today that may be the next breakthrough tomorrow.
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ACOs are groups of clinicians, hospitals, and other health-care providers that choose to come together to deliver coordinated, high-quality care to the Medicare patients they serve.
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The Advance Payment ACO Model is providing upfront and monthly payments to 20 ACOs participating in the Medicare Shared Savings Program.
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The Comprehensive ESRD Care Initiative is a new initiative designed to improve care for beneficiaries with ESRD while lowering Medicare costs.
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The Medicare Health Care Quality Demonstration is testing major changes to improve quality of care while increasing efficiency across an entire health care system.
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Nursing Home Value-Based Purchasing Demonstration provides incentive payment awards to participating nursing homes that perform the best or improve the most in terms of quality..
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A precursor to the Medicare Shared Savings Program, the Physician Group Practice Transition Demonstration rewarded groups for efficient and high quality care.
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The Pioneer ACO Model is rewarding 32 groups of health care providers experienced in working together to coordinate care.
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This demonstration is studying the quality and cost of providing PACE program services under the Medicare and Medicaid Programs.
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The Rural Community Hospital Demonstration is testing the feasibility and advisability of providing reasonable cost reimbursements for small rural hospitals.
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The Bundled Payments for Care Improvement Initiative bundles payment for an episode of care. In Model 1, retrospective bundled payments are made for acute care hospital stays only.
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The Bundled Payments for Care Improvement Initiative bundles payment for an episode of care. In Model 2, retrospective bundled payments are made for acute care hospital stay plus post-acute care.
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The Bundled Payments for Care Improvement Initiative bundles payment for an episode of care. In Model 3, retrospective bundled payments are made for post-acute care only.
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The Bundled Payments for Care Improvement Initiative bundles payment for an episode of care. In Model 4, prospective bundled payments are made for acute care hospital stays only.
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The Bundled Payments for Care Improvement intitiative evaluates 4 different models of bundled payments for a defined episode of care to incentivize care redesign.
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The Acute Care Episode (ACE) Demonstration is testing the effect of bundling Part A and B payments for episodes of acute care.
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This demonstration is testing arrangements between hospitals and physicians designed to govern the utilization of inpatient hospital resources and physician work and improve operational hospital performance with the sharing of remuneration.
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The Physician Hospital Collaboration Demonstration is examining the effects of gainsharing aimed at improving the quality of care being delivered.
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The CPC Initiative is a multi-payer initiative providing financial support to primary care practices in 7 markets.
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The Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration is testing the efficiency of patient-centered medical homes among FQHCs.
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The Frontier Extended Stay Clinic Demonstration is allowing remote clinics to treat patients for more extended periods, including overnight stays, that are entailed in routine physician visits.
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The Graduate Nurse Education Demonstration is supporting hospitals for the reasonable cost of providing clinical training to advanced practice registered nursing (APRN) training.
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The Independence at Home Demonstration is supporting home-based primary care for Medicare beneficiaries with multiple chronic conditions.
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The Medicare Coordinated Care Demonstration is testing whether providing coordinated care services to Medicare beneficiaries with complex chronic conditions can yield patient outcomes without increasing program costs.
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In the Multi-Payer Advanced Primary Care Practice Demonstration, CMS is joining in multi-payer primary care initiatives that are currently being conducted within states.
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The Medicaid Emergency Psychiatric Demonstration is supporting treatment for psychiatric emergencies at private psychiatric hospitals in 11 states and the District of Columbia.
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The Medicaid Incentives Program for the Prevention of Chronic Diseases is supporting 10 states providing incentives for Medicaid beneficiaries to participate in prevention programs and demonstrate changes in health risks and outcomes.
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Strong Start supports reducing elective deliveries prior to 39 weeks and offers enhanced prenatal care to decrease preterm births.
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Enables states to integrate care and payment systems for Medicare-Medicaid enrollees and better coordinate their care.
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Offers enhanced clinical services to beneficiaries in extended-care nursing facilities.
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The Health Care Innovation Awards are funding 106 competitive grants to compelling new ideas that deliver better health care at lower costs to people enrolled in Medicare, Medicaid and, CHIP.
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The State Innovation Models initiative is a $275 million competitive funding opportunity for States to design and test multi-payer payment and delivery models that deliver high-quality health care and improve health system performance.
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The Community-Based Care Transition Program is supporting community-based organizations to reduce readmissions by improving transitions of high-risk Medicare beneficiaries from the inpatient hospital setting to home or other care settings.
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The Innovation Advisors Program is supporting dedicated, skilled individuals in the health care system who can test new models of care delivery in their own organizations and work locally to improve the health of their communities.
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Collects data regarding physician use of advanced diagnostic imaging services to determine the appropriateness of services in relation to medical specialty guidelines.
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Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over five years.
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The Partnership for Patients is a nationwide public-private partnership that offers support to physicians, nurses and other clinicians working in and out of hospitals to reduce hospital-acquired conditions and readmissions.
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