Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, expressed urgency in pressing forward with the “triple aim” goals of better individual health care, better population health and lower costs called for in the health reform law and translated into initiatives by her predecessor.
In 2014, most of the reform provisions of the Patient Protection and Affordable Care Act (ACA) kick in and “24 months is not a lot of time” to get all the work done and fit the pieces together, she said.
Tavenner acknowledged the work of Donald Berwick, MD, who stepped down last month as CMS administrator because his recess appointment was expiring. Republican senators had blocked his confirmation as agency head.
Tavenner, a nurse and former Virginia Secretary of Health and Human Resources, awaits Senate confirmation. She had been principal deputy administrator under Berwick.
“The law was meant to build on our current system. We know what’s working and what needs improvement, and this law is the first step to make those changes in insurance company abuses, improving quality and lowering costs, better access to care and a doc fix for Medicare,” she said at the Jan. 26 Care Innovations Summit, her first conference appearance since her nomination. The summit was hosted by CMS, West Wireless Health Institute and the journal Health Affairs.
In October, the start of the 2013 federal fiscal year, Medicare will begin to pay hospitals based on their performance in quality measures through the Hospital Value-Based Purchasing Program, she said.
CMS sees coordinating care and improving technology as two critical goals and is depending on its Innovation Center over the 24 months to focus on changes in delivery models and the use of public/partnerships to spur reform.
The Innovation Center has launched delivery system initiatives to help test new models, such as accountable care organizations and medical homes with shared savings and bundled payments, and anticipates scaling nationwide what works.
Tavenner listed some of the popular ACA accomplishments to date, including filling in the prescription coverage “doughnut hole” with $250 rebate checks to Medicare recipients, creating a high risk pool for those denied insurance or extremely high risk making insurance unaffordable, and a consumer website at www.healthcare.gov that offers an insurance plan finder.
ACA has expanded coverage for young adults so parents can keep children to age 26 on their plan, including Tavenner’s daughter, she said. The law also expanded preventive services without co-pays, like flu shots and mammogram screening, which will help to lower costs over the long term.
If the Innovation Center tests a promising practice that demonstrates improvement in total cost of care and quality outcomes, the Office of the Actuary can certify that this initiative meets the criteria to be spread nationally through action by the secretary of Health and Human Services, said Dr. Rick Gilfillan, director of the CMS Innovation Center.
Some innovations run counter to the prevailing business models. “We know that providers will adopt these new practices only if they see value in them for themselves and for their patients,” he said.
Among the Innovation Center initiatives to date are:
• Multi-payer Advanced Primary Care Practices Demonstrations led by eight states to help physicians become medical homes
• Bundled Payment for Care Improvement Initiative for episodes of care around hospitalization for care redesign
• Pioneer Accountable Care Organization Model Initiative with 32 provider groups taking on financial risk for improving quality and lowering cost for Medicare patients
• State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees with 15 states redesigning care for dual eligible
• Innovation Advisors Program to train 73 providers in achieving the three-part aim
• Partnership for Patients with 3,200 hospitals targeting 40 percent reduction in hospital-acquired conditions and 20 percent reduction re-admissions within 30 days of discharge.