On November 16, 2010, the Centers for Medicare and Medicaid Services (CMS) announced the establishment of the Center for Medicare and Medicaid Innovation (CMI), under the Patent Protection and Affordable Care Act (PPACA). The acting director of the Center is Richard Gilfillan, M.D., the former president and CEO of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System.
The “Center for Medicare and Medicaid Innovation” was established by PPACA to test innovative payment and service delivery models. These models will have the goal of reducing program expenditures while preserving or enhancing the quality of care.
Under Section 3021 of the PPACA (creating a new 1115A of the SSA), CMI will be required to test a wide variety of payment and service delivery models, including those that:
- Promote broad payment and practice reform and primary care, including medical homes.
- Transition primary care services away from fee-for-service based reimbursement toward comprehensive payment or salary based payment.
- Promote innovative care delivery through risk-based comprehensive payment or salary-based payment.
- Utilize geriatric assessments and comprehensive care plans to coordinate the care of individuals with multiple chronic conditions.
- Support care coordination for chronically ill individuals at high risk of hospitalization, through a health information technology enabled provider network.
- Vary payment to physicians for advanced diagnostic imaging services, based upon adherence to “appropriateness criteria for the ordering of such services.”
- Use medication therapy management services.
- Employ community based health terms to support small practice medical homes.
- Assist individuals in making informed healthcare choices by paying providers for using patient decision support tools that improve patient and caregiver understanding of treatment options.
- Improve post acute care through continuing care hospitals that offer inpatient rehabilitation, long term care hospitals, and home health or skilled nursing care during an inpatient stay and the 30 days immediately following discharge.