One of the many new entities created by the Patient Protection and Affordable Care Act (the Act) is the Center for Medicare and Medicaid Innovation or “CMI,” which will be part of CMS. The goal of CMI is to test the impact that innovative payment and service delivery models have on the cost and quality of health care services.
Preference for selecting new delivery models to test will be given to those models that improve coordination, quality, and efficiency of health care services. The models further must target a defined patient population for which there are “deficits of care leading to poor clinical outcomes or potentially avoidable expenditures.” The Secretary also may limit testing to certain geographical areas.
CMI is required to consult with relevant federal agency representatives as well as with clinical and analytical experts in medicine and healthcare management. “Open door forums” will be conducted to seek input from interested parties.
Models will be evaluated based on an analysis of the quality of care furnished, including the measurement of patient-level outcomes and patient-centeredness criteria, and the effect of the model on program costs. The Secretary is charged with publicizing the evaluation results for each model reviewed.
The Act requires that CMI be operational by January 1, 2011. Over 10 billion dollars have been appropriated for CMI activities for 2010-2019. To read this section of the Act, click here.