Fwd: qotd: CMS limits innovative designs to multi-payer models

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-------- Original Message --------
Subject: qotd: CMS limits innovative designs to multi-payer models
Date: Fri, 22 Feb 2013 11:37:55 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Centers for Medicare and Medicaid Services
Center for Medicare and Medicaid Innovation
February 2013
State Innovation Models Initiative: General Information

The State Innovation Models Initiative is providing up to $300 million
to support the development and testing of state-based models for
multi-payer payment and health care delivery system transformation with
the aim of improving health system performance for residents of
participating states. The projects will be broad based and focus on
people enrolled in Medicare, Medicaid and the Children's Health
Insurance Program (CHIP).

Background

The Innovation Center created the State Innovation Models initiative for
states that are prepared for or committed to planning, designing,
testing, and supporting evaluation of new payment and service delivery
models in the context of larger health system transformation. The
Innovation Center is interested in testing innovative payment and
service delivery models that have the potential to lower costs for
Medicare, Medicaid, and the Children's Health Insurance Program (CHIP),
while maintaining or improving quality of care for program
beneficiaries. The goal is to create multi-payer models with a broad
mission to raise community health status and reduce long term health
risks for beneficiaries of Medicare, Medicaid, and the Children's Health
Insurance Program (CHIP).

For more information, click on "Fact Sheet: State Innovation Models
Initiative" at this link:

http://innovation.cms.gov/initiatives/State-Innovations/

And...

State of Hawaii
February 21, 2013
State Receives $937,691 Grant to Continue Healthcare Transformation Efforts

The State of Hawaii once again has an opportunity to demonstrate its
leadership in healthcare transformation. The Centers for Medicare and
Medicaid Services (CMS) today announced that Hawaii was awarded a
planning grant worth $937,691 as part of the agency's State Innovations
Model (SIM) initiative.

Beginning April 1, the state will have six months to design and submit a
State Healthcare Innovation Plan, built around multipayer payment and
healthcare delivery system transformation.

"Transforming our state's healthcare system continues to be a focus of
my New Day plan, and under the leadership of Beth Giesting, the state's
healthcare transformation coordinator, we've made great strides over the
last year," said Gov. Neil Abercrombie.

http://governor.hawaii.gov/state-receives-937691-grant-to-continue-healthcare-transformation-efforts/


Comment: Section 3021 of the Affordable Care Act establishes the Center
for Medicare and Medicaid Innovation. Its purpose is "to test innovative
payment and service delivery models to reduce program expenditures under
the applicable titles (Medicare and Medicaid) while preserving or
enhancing the quality of care furnished to individuals under such titles."

The law lists "opportunities" for models to be tested, including
"allowing states to test and evaluate systems of all-payer payment
reform for the medical care of residents of the state." Of note, nowhere
does section 3021 limit the innovative testing to "multi-payer models."
Yet CMS now states that "the goal is to create multi-payer models."

To show how important this administrative decision is, look at Hawaii.
Gov. Neil Abercrombie has been a single payer supporter. He was a
cosponsor of H.R. 676, John Conyers' single payer bill, when he was a
member of Congress. Efforts have recently been underway to move Hawaii
towards becoming a single payer state. But now with this grant, Hawaii
is going to "design and submit a State Healthcare Innovation Plan, built
around multipayer payment and healthcare delivery system transformation."

The CMS fact sheet (link above) list other states receiving funds under
this program, including states that were thought to be in a position to
lead the way on single payer reform, such as Vermont and California.

According to the fact sheet, Vermont has been awarded a $45 million
grant to establish "three models: a shared-savings ACO model that
involves integration of payment and services across an entire delivery
system; a bundled payment model that involve integration of payment and
services across multiple independent providers; and a
pay-for-performance model aimed at improving the quality, performance,
and efficiency of individual providers." That doesn't exactly have a
single payer ring to it.

Although the law did not limit the innovations to be developed and
tested to multi-payer models, the Obama administration has. Once again,
single payer advocates have been denied a seat at the table. What are we
going to do about it?