Medicare Initiatives Authorized by The Affordable Care Act
Nancy B. OConnor Regional Administrator October 25, 2012 Richmond,
VA
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Topics for Today CMS Background The case for patient-centered
care The ACA-arsenal of health home options MAPCP CPCI Independence
at Home Medicaid Health Home Accountable Care Organizations
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About CMS Mission CMS is a constructive force and a trustworthy
partner for the continual improvement of health and health care for
all Americans. Largest health insurer in the country Over 100
million covered lives Over 1 million Medicare physicians 31
Medicare contractors Medicare/Medicaid/CHIP=$937 billion Top
Priorities Keep the trains running Implement the Affordable Care
Act Lead the improvement of health care in America New logo!
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CMS Ten Regional Offices
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Unsustainable Escalating Costs Excessive Services ACA lays the
foundation for transformation Provide better care Promote better
health Lower costs The State of Health Care
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Incentives for Delivering Integrated Primary Care Multi-payer
advanced primary care demonstration Comprehensive Primary Care
Initiative Independence at Home Medicaid Health Home Accountable
Care Organizations Medicare Shared Savings Program (MSSP Pioneer
Advanced Payment Integrating Care Delivery
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Multi-payer Advanced Primary Care Practice Model (MAPCP)
Medicare will participate in existing State multi- payer health
reform initiatives that currently include participation from both
Medicaid and private health plans. The demonstration program will
pay a monthly care management fee for beneficiaries receiving
primary care from APC practices Eight states selected to
participate By end of year 3, up to 1200 practices caring for
~900,000 beneficiaries 7
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A major barrier to transformation in practice is transformation
in payment Will test two models simultaneously: Practice Redesign
Provision of core primary care functions Better use of data Payment
Redesign PBPM care management fee Shared Savings opportunity
Comprehensive Primary Care Initiative 8
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Additional Health Home Models Independence at Home A payment
incentive and service delivery model utilizing physician and nurse
practitioner teams Reduce preventable hospitalizations,
readmissions, and ER visits Improve health outcomes, and care
efficiency Medicaid Health Home Option for all states very flexible
Enhanced financial resources 9
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ACO Models Pioneer Model Designed for organizations well on
their way to changing their care delivery/business models Advanced
Payment Model Gives certain ACOs access to up front shared savings
Medicare Shared Savings Program Facilitate coordination and
cooperation among providers 10
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Lessons Learned Getting to 5,000 assigned members Coordination
takes time Physician champion are key to success Reliable data
partner/IT infrastructure for analysis ACO management can drive
provider conversation 11