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Innovation and Risk: Transitioning Through Payment Reform Activities

Innovation and Risk: Transitioning Through Payment Reform Activities. Indiana Rural Health Association 17th Annual Rural Health Conference June 10 – 11, 2014. Discussion Overview. Payment Reform: A Market in Transition Innovation Payment Models

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Innovation and Risk: Transitioning Through Payment Reform Activities

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  1. Innovation and Risk:Transitioning Through Payment Reform Activities

    Indiana Rural Health Association 17th Annual Rural Health Conference June 10 – 11, 2014
  2. Discussion Overview Payment Reform: A Market in Transition Innovation Payment Models Regulatory Environment & Other Market Influences

  3. Payment Reform: A Market in Transition

  4. True Reform Will Require Disruptive Innovation* Simplifying Technology Low Cost Business Models Value Network Regulations & Standards That Facilitate Change * Source: “The Innovator’s Prescription” by Clayton M. Christensen
  5. Supreme Court Examines Constitutionality U.S. Supreme Court Ruling: June 28, 2012
  6. The Foundation: Value-Based Payment Value Based Payment: “a reform initiative whereby health care providers will receive payment for service based on their performance or the potential outcomes of the service” Tying payment to performance is perhaps the most significant aspect of health care reform. The de facto definition of “value” in health care reform is the intersection of lower cost and improved quality. Providers who can lower costs and deliver quality will be measured as “value-based providers” Lower Cost Value Improved Quality

  7. Innovation Payment Models

  8. Where Payment Reform is Happening* * Source: Americas Health Insurance Plans (AHIP) accessed via web on 9/3/13 at: http://www.ahip.org/searchResults.aspx?searchtext=payment reform activity
  9. Payment Reform Models Focus:Behavior-Intensive Diseases w/Deferred Consequences Diseases with Immediate Consequences Strong: Immediate Consequences Myopia Chronic Back Pain Psoriasis Infertility Hypothyroidism GERD Crohn’s Disease Allergies Celiac Disease Ulcerative Colitis Multiple Sclerosis Depression Sickle Cell Anemia Epilepsy HIV Type I Diabetes Behavior dependent diseases Technology Dependent Diseases Motivation to Comply With Best Known Therapy Parkinson Asthma Congestive Heart Failure Cystic Fibrosis Crushing costs of caring for chronically ill are in this quadrant: diabetes, asthma, tobacco, obesity, CHF, affect tens of millions of people each. Coronary Artery Disease Type II Diabetes Chronic Hepatitis B Schizophrenia Osteoporosis Alzheimer’s Cerebrovascular Disease Hypertension Weak: Deferred Consequences Bipolar Disorder Obesity Hyperlipidemia Diseaseswith deferred consequences Addictions Minimal Extensive Degree to Which Behavior Change is Required Source: “The Innovator’s Prescription” by Clayton M. Christensen
  10. Chronic Disease Burden on Medicare Spending* Zero or 1 condition Zero or 1 condition 2 or 3 conditions 4 to 5 conditions 2 or 3 conditions 4 to 5 conditions 6 or more conditions 6 or more conditions * Source: MedPAC March 2014 Report to Congress
  11. CMS Defined Innovation Models * Primary Care Transformation Comprehensive Primary Care Initiative FQHC Advance Primary Care Practice Demonstration Graduate Nurse Education Demonstration Independence at Home Demonstration Multi-Payer Advanced Primary Care Practice Accountable Care Medicare Shared Savings Program Medicare Advanced Payment ACO Pioneer ACO Comprehensive ESRD Care Initiative (LI/App.) Bundled Payment for Care Improvement Models 1 through 4 * Arising as a result of Affordable Care Act (ACA), and excluding programs in effect prior to ACA.
  12. CMS Defined Innovation Models * Initiatives to Accelerate Testing & Development of New Models Health Innovation Awards State Innovation Models Initiatives to Speed Adoption of New Models Community Based Care Transitions Programs Innovation Advisors Program Million Hearts Partnerships for Patients Medicaid & CHIP Initiatives Emergency Psychiatric Demonstration Incentives for Prevention of Chronic Diseases Model Strong Start for Mothers & Newborns Initiative Reduce Early Elective Deliveries Enhanced Prenatal Care Models Medicare-Medicaid Enrollees Initiatives Financial Alignment Incentives Reduce Avoidable Hospitalizations Among Nursing Facility Residents * Arising as a result of Affordable Care Act (ACA), and excluding programs in effect prior to ACA.
  13. ACOs Continue to Grow On December 23rd CMS announced that 123 new organizations will join the Medicare ACO program effective January 1, 2014 ACO enrollment has evolved and continued to grow since it was launched in April 2012: April 2012 initial: 27 organizations July 2012: 89 additional organizations January 2013: 106 additional organizations December 2011: 32 Pioneer ACOs, w/~ 23 remaining Total ACO participation Over 360 organizations More than 5.3 million beneficiaries More than 50% of ACOs led by physician groups, with < 10,000 beneficiaries
  14. ACO Results to Date * Pioneer ACO First Year Results: Cost Reduction/Shared Savings: Cost growth rate for 669,000 beneficiaries .3% vs. .8% 13 participants generated gross savings of $87.6 million 2 participants generated losses of approximately $4 million Quality Metrics 100% successfully reported quality measures Overall performed better for all 15 clinical quality measures 25 of 32 generated lower risk-adjusted readmissions rates Median rate for blood pressure control for beneficiaries with diabetes was 69% vs. 55% Median rate for LDL cholesterol control for patients with diabetes was 57% vs. 48% CMS expects MSSP results later in year * Source: CMS “Pioneer Accountable Care Organizations succeed in improving care, lowering costs” July 16, 2013
  15. Medicare Bundled Payments for Care:Medicare’s Largest Payment Innovation Program BPCI1 Participation by State More than 450 Providers Participating in BPCI1 Source: The Advisory Board
  16. BCPI Participants Favoring Longer Episodes Participation by Model Type Source: Centers for Medicare and Medicaid Services; Health Care Advisory Board interviews and analysis. Hospital Inpatient Services Hospital and Physician Inpatient and Post-Discharge Services Post-Discharge Services Hospital and Physician Inpatient Services
  17. CMS Bundled Payments Initiatives: What is Being Bundled? Source: The Advisory Board: “What are BPCI participants bundling?” by Rob Lazerow dated February 1, 2013
  18. Bundled Payments:Understanding Bundle Characteristics Bundle Risk: Approximately 51% of total bundle costs occurred post-discharge! CONFIDENTIAL: Subject to CMS Data Use Agreement #22626
  19. Bundled Payments:The Post Acute Care Path and Impact on Bundle Acute Stay Discharge CONFIDENTIAL: Subject to CMS Data Use Agreement #22626
  20. Commercial Insurance BPI Activity: Large Employers Cardiovascular & Spine Services Bundles Payer: Walmart Six Participating Providers: Virginia Mason Medical Center, Seattle, WA Mayo Clinic, Scottsdale, AZ , Rochester, MN & Jacksonville, FL Scott & White Memorial Hospital, Temple, TX Mercy Hospital, Springfield, MO Cleveland Clinic, Cleveland, OH Geisinger, Danville, PA Description: Beginning January 2013 1.1 million employees eligible for consultation and care for certain cardiac & Spine procedures at no additional cost. Walmart will cover cost of travel, lodging, and food for patient and one caregiver. Payer: PepsiCo Participating Providers: John Hopkins, Baltimore, MD Description: Starting 12/11 began waiving deductibles & co-insurance for employees who receive cardiac and complex joint replacement surgery at John Hopkins. Payer: Lowes Participating Providers: Cleveland Clinic, Cleveland, OH Description: Contract for heart surgery program; will waive $500 deductible, out-of-pocket costs, airfare, hotel and living expenses. Source: The Advisory Board “Commercial Bundled Payment Tracker” accessed via web on 4/12/13 at: http://www.advisory.com/Research/Health-Care-Advisory-Board/Resources/2013/Commercial-Bundled-Payment-Tracker#lightbox/0/
  21. CMS Primary Care Transformation Comprehensive Primary Care Initiative Multi-payer initiative fostering collaboration between public and private health care payers. 497 primary care practices covering 7 states Includes 2,347 providers serving an estimated 315,000 Medicare Beneficiaries Independence at Home Demonstration Tests the effectiveness of delivering comprehensive primary care services to Medicare beneficiaries with multiple chronic conditions at home. Providers who succeed in reducing costs and meeting designated quality measures will receive an incentive payment. Participants announced in April 2012 and include 15 different practices in 12 different states Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  22. CMS Primary Care Transformation Multi-Payer Advanced Primary Care Practice CMS participating in 8 states with multi-payer reform initiatives already being conducted in states. Demonstration focuses in on if advanced primary care practice will reduce unjustified utilization and expenditures, improve safety, effectiveness and timeliness and efficiency of health care services. Monthly care management fee is paid to cover care coordination, improved access, patient education, and other services to support chronically ill patients. FQHC Advanced Primary Care Practice A three-year demonstration program designed to evaluate the effect of advanced primary care practice model (commonly referred to PCMH) in improving care, promoting health, and reducing cost of care to Medicare beneficiaries served by FQHCs. 493 participating FQHCs will be paid a monthly care management fee of $6.00 (paid quarterly) per eligible beneficiary attributed to their practice. Fee is in addition to the usual all-inclusive payment rate currently received. Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  23. Patient Centered Medical Home – Demonstration Project Overview * Project Objectives: Identify and eliminate “gaps” in care Reduction of health risk factors and enhancement of quality of life Focused Clinical Conditions: Asthma Coronary Artery Disease Hyperlipidemia Hypertension Adult/Adolescent/Childhood Immunizations COPD Diabetes Anxiety/Depression Breast/Cervical/Colorectal Cancer Screenings Vital & Others * Source: BCBSMT Presentation at MT HFMA on PCMH Demonstration Project Results Fall, 2011
  24. Patient Centered Medical Home: Demonstration Project Incentive Plan* Structure Incentives Based on Outcomes Participation Amount Quality Outcome Amount Patient Satisfaction TCOC Amount Incentive s for Both Improving & Achieving Targets Additional Payment Incentives $200 PMPY for Care Management of Chronic Conditions $100 PMPY for Care Management of Preventive Conditions Potential Savings Reduced ER visits Preventable Admissions & Re-Admissions Improved Health Status Increased Productivity, Employee Morale & Reduced Absenteeism * Source: BCBSMT Presentation at MT HFMA on PCMH Demonstration Project Results Fall, 2011
  25. Patient Centered Medical Home: Demonstration Project Outcomes*
  26. State Innovation Model Initiatives Provides up to $300 million to support the development and testing of state-based delivery system transformation models for multi-payer payment and health care delivery system.

  27. Regulatory Environment &Other Market Influences

  28. Influencers of Medicare Reimbursement Patient Protection & Affordable Care Act (PPACA) March 2010 American Taxpayer Relief Act January 2013 MedPAC & OIG 2013 Reports New formula for DSH payments. Established requirements for pay-for-performance initiatives “Payment equalization across sites of service” Elimination of CAH designation for 849 of 1,329 CAHs President Obama’s September 2011 budget CAH swingbed reimbursement vs. skilled nursing facilities Rural Health Clinic (RHC) designation and rules compliance Grants CMS authority to recoup “excess payments”in “exchange” for temporary SGR patch Bipartisan Budget Act of 2013 Extended provisions of ATRA, including SGR, through 3/31/14 Protecting Access to Medicare Act of 2014 Extends provisions of ATRA for 1 year CMS Annual Updates ACA implementation Value-Based-Payment Readmissions DSH Implementation
  29. MedPAC Pushing EqualizationPayment Pressures: “Good Ole Days” At Risk “Last year we made a recommendation to equalize payment rates for office visits provided in hospital outpatient departments and physician offices. We will continue to analyze opportunities for applying this principle to other services and sectors, such as sectors that provide post-acute care.” MedPAC 2013 Report to Congress “Medicare often pays different amounts for similar services across settings. Basing the payment rate on the rate in the most efficient clinically appropriate setting would save money for Medicare… We extend that principle to specific services that meet the Commission’s criteria….” MedPAC 2014 Report to Congress
  30. MedPAC Payment Equalization Recommendations Identified 5 criteria for services that are “good candidates” Frequently (> 50%) performed in physicians office Minimal packaging differences across payment systems Infrequently provided in ED Severity no greater in HOPD then freestanding offices Do not have a 90-day global surgical code Broke 450 APCs into two groups based on service category: Group 1: 66 APCs Characteristics: No emergency standby required; no extra costs associated with complexity; no additional overhead Group 2: 42 APCs Characteristics: Met 4 of the 5 above characteristics Okay to exceed PFS rate, but only equal to cost of additional packaging Estimated reductions of $1.1B LTCH Non-Chronic Critical Payment Rate Reduced from ~ $40,000/ case to ~ $12,000/case (similar to IP PPS) Shift differential, ~ $2B, to IP PPS to increase outlier reimbursement for CCI patients
  31. Transitioning to a New Market Place * Indiana Marketplace ** Potential Size: 525,000 Completed Applications: 229,815 Enrollment: 132,423 Estimate of Uninsured Eligible for Medicaid/CHIP: 94,495 Assistance Eligible: 155,961 * Source: State Reforum an online network for health reform implementation at https://www.statereforum.org/tracking-health-coverage-enrollment-by-state ** Source: Department of HHS; “Health Insurance Marketplace: Summary of Enrollment for the Initial Annual Open Enrollment Period” 10/1/13-4/19/14.
  32. Trading Price for Volume on the Public Exchanges Expect Lower Provider Payment Rates, Less Patient Choice Source: Mathews AW and Kamp J, “Another Big Step in Reshaping HealthCare,” Wall Street Journal, February 28, 2013, available at: www.online.wsj.com; Hancock J, “Aetna Cuts Predictions for Obamacare Enrollment,” Kaiser Health News, April 30, 2013, available at: www.capsules.kaiserhealthnews.org; Health Care Advisory Board interviews and analysis. Pseudonym. Anticipated Provider Reimbursement Rates for Exchange Plans Aetna’s Planned Reduction in Exchange Network Size 25%-50% reduction in exchange network size, compared to networks for typical commercial products WellPoint Inc. Between Medicare and Medicaid rates Catholic Health Initiatives Modest discounts from commercial rates Millern Medical Center1 20% below commercial rates Meyers Health1 10% above Medicare rates Case in Brief: Aetna Inc. Health insurer planning to sell narrow network exchange products in 14 states Searching for providers agreeing to lower rates in narrow network products Plans for rates to fall closer to Medicare than commercial reimbursement Tenet Healthcare Up to 10% below commercial rates Meriwether Hospital1 5% below commercial rates
  33. Growth in Spending Will Dictate Risk:Factors Influencing Spending Growth* Source: MedPAC Report to Congress, March 2014
  34. Will Access to Coverage Kick-Start Spending Growth? Health care spending rose at fastest rate in 10 years in 4Q of 2013 at 5.6% ** Hospital revenue grew by $8 billion, despite 1% decrease in IP days Reasons behind the increase: Trend of shifting > out of pocket to insured leveling off Upward pressures on costs, such as high-tech treatments, are remerging Since 2011 unemployment has dropped from 8.5% to 6.7%, adding 2.6 million jobs “The Centers for Medicare and Medicaid Services expects health spending to rise 6.1% this year……as 11 million people gain health insurance.”** ** Source: USA Today “Health care spending growth hits 10-year high”
  35. Emerging Risk in Commercial Contracting Background Insurer is implementing a new payment system and provided estimated impact of conversion. Estimated impact of the change was a reduction of net revenues of about $831,000 (14%) However, as claims are being processed the impact is greater than initially estimated Application of LCC rule further reduces net revenues by $954,000 (-16%) Revised Estimated Impact Baseline Conversion Impact ($831,000) Additional Reduction Due to Application of Claim Level LCC ($954,000) TOTAL NET REVENUE IMPACT OF NEW CONTRACT ($1,785,000) Overall % Reduction in Payor Revenue -30%
  36. Emerging Risk in Commercial Contracting (cont’d) Overall Payment Rate (2012 Pricing) What it used to be under the old contract Initial estimate based on analysis of new contract Actual rate from paying at lower of allowable or charges at a claim level (LCC)
  37. Introduction of New Competion:Walmart Eying the Health Care Industry Moving Beyond Basic Retail Clinics Source: The Advisory Board Holmes TJ, “The Diffusion of Wal-Mart and Economics of Density,” May, 2006; Zimmerman A and Hudson K, “Managing Wal-Mart: How U.S.-Store Chief Hopes to Fix Wal-Mart,” The Wall Street Journal, April 17, 2006, available at: www.wsj.com; Aboraya A, “Wal-Mart Plans to Offer Primary Care in 5-7 Years,” Orlando Business Journal, January 11, 2013, available at: www.bizjournals.com/orlando; Aboraya A, “Exclusive: Wal-Mart Exploring Private Health Insurance Exchange for Small Biz,” Orlando Business Journal, January 11, 2013, available at: www.bizjournals.com/orlando; Health Care Advisory Board interviews and analysis. Scope of Services ” Potential Evolution of Health Care Products Basic Retail Clinic Full Primary Care Health Insurance Exchange “That’s where we’re going now: full primary care services in five to seven years.” Vice President Health and Wellness Payer Relations 4,600+ 4.2 miles 33% Median distance between a residence and Walmart Estimated portion of the US population that visits Walmart every week Number of Walmart stores in the United States 37
  38. Introduction of New Competion:Beyond Walmart Walgreens Aims to Become the Premier Health Destination Source: The Advisory Board JapsenB, “How Flu Shorts Became Big Sales Booster for Walgreen, CVS,” Forbes, February 8, 2013, available at: www.forbes.com; “Take Care Clinics at Select Walgreens Expand Service Offerings,” Reuters, May 31, 2012, available at: www.reuters.com; Murphy T, “Drugstore Clinics Expand Care into Chronic Illness,” The Salt Lake Tribune, April 4, 2013, available at: www.sltrib.com, Walgreens, “Company Overview,” available at: www.walgreens.com; Health Care Advisory Board interviews and analysis. ” 2013: Launches three ACOs; begins diagnosing and managing chronic disease 2009: Launches flu vaccine campaign Simple Acute Services Vaccinations and Physicals Chronic Disease Monitoring Chronic Disease Diagnosis and Management 2007: Acquires Take Care Health Systems 2012: Offers three new chronic disease tests Case in Brief: Walgreen Co. Not Just a Drugstore Largest drug retail chain in the United States, with 372 Take Care Clinics In April 2013, became first retail clinic to offer diagnosis and treatment of chronic diseases “Our vision is to become ‘My Walgreens’ for everyone in America by transforming the traditional drugstore into a health and daily living destination...” Walgreen Co. Overview 38
  39. 2014 Market Transitions to Monitor Transitioning commercial contracting More “stiff arming” especially for smaller providers Exchange related impacts Glitch continuation? Reimbursement implications “Surprise” narrow networks ? Increased demand for medical services Reprieves from mandates – how long will they last? Consumer impact – choice & out-of-pocket costs Escalation in ruthless competition Formation of narrow networks impacting market share On-going provider operational challenges Revenue cycle issues Profitability continues to be squeezed Charge capture issues
  40. Parting Comments Health care payment system is being driven to “value based” payments The transition in large part is market driven Many of the initiatives take aim at improving management, access, and quality of care provided to patients with chronic conditions Short-term outcomes show promise, but it will be years before we understand the true benefit of this transition Outside of new innovation models, some of payment reform activity is not all that innovative Transition market is creating unique competition challenges
  41. Questions/Comments THANK YOU! Rob Schile, CPA MP Health Systems Rob.Schile@claconect.com For information on health care reform, go to CliftonLarsonAllen’s Health Care Reform Center at: http://www.cliftonlarsonallen.com/healthreform/

  42. Appendix: Indiana Payment Innovation Initiatives

  43. Indiana Innovation ActivityACO Participation Advanced Payment ACO American Health Network of Ohio Care Organization, LLC (Indianapolis) Pioneer ACO Franciscan Alliance (Indianapolis) Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  44. Indiana Innovation ActivityBPCI Model 2 Participation Bone & Joint Specialists, P.C. (Merrillville) Central Indiana Orthopedics (Muncie) Clark Memorial Hospital (Jeffersonville) Community Hospital of Anderson and Madison County, Inc. (Anderson) Community Hospital South, Inc. (Indianapolis) Community Hospitals of Indiana, Inc. (Indianapolis) Community Physicians of Indiana, Inc. (Indianapolis) Heart Group, PC (Evansville) Indiana Heart Hospital, LLC (Indianapolis) Indiana Hospitalists PC (Richmond) Indianapolis Osteopathic Hospital, Inc. (Indianapolis) Orthopaedics Indianapolis, Inc. (Indianapolis) Premier Healthcare, Llc (Bloomington) Providence Medical Group Llc (Terre Haute) Saint Joseph Regional Medical Center – Mishawaka Campus (Mishawaka) Saint Joseph Regional Medical Center – South Bend Campus (Mishawaka) St. Joseph Regional Medical Center – Plymouth Campus) Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  45. Indiana Innovation ActivityBPCI Model 3 Participation Amedisys Home Health of Jeffersonville (Jeffersonville) Bone & Joint Specialists, P.C. (Merrillville) Chicagoland Christian Village, Inc. (Crown Point) Community Physicians of Indiana, Inc. (Indianapolis) Covenant Care Indiana Inc. University Park Health and Rehabilitation Center (Fort Wayne) Decatur Township Center (Indianapolis) Heart Group PC (Evansville) Home Health Care Solutions (Avon) Hoosier Christian Village, Inc. (Indianapolis) Indiana Hospitalists PC (Richmond) Indianapolis Osteopathic Hospital Inc. (Indianapolis) Lakeland Skilled Nursing & Rehab (Angola) McCormick’s Creek Rehabilitation & Skilled Nursing Facility (Spencer) Miller’s Merry Manor (31 locations) New Haven Care Center (New Haven) Norwood Health & Rehabilitation Center (Huntington) Oak Health Care Investors, Inc. (Butler) Orthopaedics Indianapolis, Inc. (Indianapolis) Premier Healthcare Llc (Bloomington) Providence Medical Group (Terre Haute) Pyramid Point Post-Acute & Rehab Center (Indianapolis) Waldron Health & Rehab Center (Waldron) Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  46. Indiana Innovation ActivityFQHC Demonstration Indiana Participants Cass County Community Health Center (Logansport, IN) Community Health Center of Jackson County (Seymour, IN) HealthLinc, Inc. (Valparaiso, IN) Indiana Health Centers, Inc. South Bend, IN Kokomo, IN Vermillion-Parke Community Health Center (Clinton, IN) 3 year demonstration Help Medicare beneficiaries manage chronic conditions and provide coordinated care Receive $6 monthly care management fee for each eligible Medicare beneficiary Achieve Level 3 patient-centered medical home recognition Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  47. CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity Health Care Innovation Awards: Trustees of Indiana University: Project Title: “Dissemination of The Aging Brain Care Program” (ABC) Geographic Reach: Indiana Funding Amount: $7.8 Million Est. 3 Year Savings: $15.7 Million Project Summary: Reduce behavioral and psychological symptoms of dementia, improve patients’ or informal caregivers’ satisfaction and access to care, improve the quality of dementia and depression care, and reduce acute care utilization. Expansion of The Aging Brain Care (ABC) program which has been in effect for 2 years serving > 200 patients. ABC will expand to more than 2,000 Medicare & Medicaid beneficiaries with dementia and late-life depression to accomplish the stated project goals. Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  48. CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity Health Care Innovation Awards: TransforMed Geographic Reach: AL, CT, FL, GA, IN, KS, KT, MD, MA, MI, MS, NA, NC, OK, SD, WV Funding Amount: $20.7M Est. 3 Year Savings: $52.8M Project Summary: Primary care redesign project across 15 communities to support care coordination among Patient-Centered Medical Homes (PCMH), specialty practices, and hospitals, creating “medical neighborhoods”. Project will utilize sophisticated data analytics to identify high risk patients and coordinate care across the medical neighborhood while driving PCMH transformation in primary care practices in each community. Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  49. CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity Health Care Innovation Awards: Nat’l Council of YMCA of USA Geographic Reach: AZ, DL, FL, IN, MN, NY, OH, TX Funding Amount: $11.9M Est. 3 Year Savings: $4.3M Project Summary: In partnership with other non-profit organizations, will expand YMCA’s Diabetes Prevention Program to prediabetic Medicare beneficiaries in 17 communities. Deliver community-based diabetes prevention through a nationally recognized diabetes prevention lifestyle change program, coordinated and taught by trained YMCA Lifestyle Coaches. Goal is to prevent the progression of prediabetes to diabetes, which will improve health and decrease costs associated with complications of diabetes, hypercholesterolemia and hypertension. Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  50. CMS Centers for Medicare & Medicaid Innovation (CMMI): Indiana Innovation Activity Health Care Innovation Awards: Feinstein Institute for Medical Research Geographic Reach: FL, IN, MI, MO, NH, NM, NY, OR Funding Amount: $9.4M Est. 3 Year Savings: $10.1M Project Summary: Develop a workforce capable of delivering effective treatments, using newly available technologies to at-risk, high-cost patients with schizophrenia Provide training and education to patients and caregivers about pharmacologic management, cognitive behavior therapy, and web-based/home-based monitoring tools for their conditions intended to improve patients quality of life and lower cost by reducing hospitalizations. Source: The Centers for Medicare & Medicaid Innovation (CMMI)
  51. Indiana Innovation ActivityCCMI Initiatives to Speed Adoption of New Models Community Based Care Transitions Program Section 3026 of ACA Test models for improving care transition from hospital to other settings and reducing readmissions for high risk Medicare beneficiaries 102 total participants Indiana Participants: Aging & In-Home Services of Northeast Indiana (Fort Wayne, IN) LifeSpan Resources, Inc. (New Albany, IN) Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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