The Centers for Medicare and Medicaid Innovation Center was created by Congress [section 1115A of the Social Security Act as a result of section 3021 of the Affordable Care Act] to test on a nationwide basis “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program benefits.” Top priorities of the Center for Medicare & Medicaid Innovation (CMMI) are to “[evaluate] results and advance best practices, [engage] a broad range of stakeholders to develop additional models for testing” and “[test] new payment and service delivery models.” Models for experimental designs are organized into seven categories:
- accountable care,
- bundled payments for care improvement,
- primary care transformation,
- Medicaid/CHIP population,
- Medicaid-Medicare enrollees,
- speedy adoption of best practices, and
- development and testing of new payment and service delivery models.
Initiatives seeking CMMI grants to test experimental designs “must either reduce spending without reducing the quality of care, or improve the quality of care without increasing spending, and must not deny or limit the coverage or provision of any benefits.”
One such CMMI grantee is the Johns Hopkins Community Health Partnership or J-CHiP. Operating at Hopkins’ two large hospitals and at various sites throughout Baltimore, this program “looks at ways to overcome health disparities in the community among Hopkins patients.” These patients suffer disproportionally from substance use disorders, psychiatric conditions such as depression and anxiety, and post-traumatic stress disorder – all conditions that contribute to avoidable morbidity and high costs if untreated. Primary care physicians, nurse care managers, and 75 local community health workers make up the team that provides treatment and follow-up with patients to help track self-management, adherence to recommended treatment, and barriers to care. Patients undergo a much broader assessment than is standard in primary care. Behavioral health factors such as nutrition, emotional status, sleep, substance use, domestic violence, cognitive function, and medication adherence are assessed; and attainable, measurable coping skills are established with the patient. This model ultimately “hopes to bring a new workforce to bear on health behavior and psychiatric conditions in primary care, along with increased accountability for coordination.” In order for this model to fully succeed, existing silos of care must be broken down and the traditional primary care workforce will need additional training in techniques such as interviewing. Essential elements of program success are dedicated and committed team members, including an experienced community psychiatrist.
Read more about CMMI: http://innovation.cms.gov/index.html
Read more about J-CHiP: http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1765222