A model ap­proach

Grants aim to bol­ster care qual­ity, slash costs

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

As state gov­er­nors wres­tle with Med­i­caid ex­pan­sion and health in­sur­ance ex­change im­ple­men­ta­tion, they now have an­other fed­eral fund­ing op­por­tu­nity to test new health­care pay­ment and de­liv­ery mod­els in their states.

HHS an­nounced last week the State In­no­va­tion Mod­els ini­tia­tive, a $275 mil­lion com­pet­i­tive fund­ing pro­gram that will al­low the 50 gov­er­nors and the mayor of Wash­ing­ton, D.C., to ap­ply for ei­ther “model de­sign” or “model test­ing” awards for mod­els that aim to im­prove care and lower costs for Medi­care, Med­i­caid and Chil­dren’s Health In­sur­ance Pro­gram ben­e­fi­cia­ries.

The CMS In­no­va­tion Cen­ter will over­see the pro­gram, which will award up to a to­tal of $50 mil­lion for up to 25 states in the de­sign cat­e­gory and up to a to­tal of $225 mil­lion for up to five states over three to four years for the test­ing ap­pli­ca­tions.

“These awards are an in­cen­tive for states to re­cruit part­ners and ac­cel­er­ate the work that many of them are al­ready do­ing to im­prove health­care and lower costs,” CMS act­ing Ad­min­is­tra­tor Mar­i­lyn Taven­ner said in a news an­nounce­ment.

Fund­ing for the model de­sign awards is meant to pro­vide fi­nan­cial and tech­ni­cal sup­port to states in their plan­ning ef­forts. In their

pro­pos­als, states must in­clude a range of play­ers in the process, such as health­care providers, con­sumers, em­ploy­ers, unions, community lead­ers and pub­lic and pri­vate pay­ers.

HHS also urged states to build on ex­ist­ing state waivers and fed­eral health re­form ini­tia­tives. They must also de­velop and sub­mit a health­care in­no­va­tion plan that shows how the state in­tends to trans­form its health­care de­liv­ery sys­tem with a strat­egy that de­liv­ers higher qual­ity and bet­ter value for care. Ac­cord­ing to HHS, these plans will form the ba­sis for a sec­ond round of fund­ing that is expected next spring.

Mean­while, states ap­ply­ing for model test­ing awards must have a state health­care in­no­va­tion plan and show how their pro­posed ap­proach would ad­dress so­cial, eco­nomic and be­hav­ioral de­ter­mi­nants of health and re­duce dis­par­i­ties. They must also de­scribe the pol­icy, reg­u­la­tory or leg­isla­tive author­ity that will sup­port the model; ex­plain how the model will build on ex­ist­ing health­care re­form ini­tia­tives; and de­scribe a process for per­for­mance mon­i­tor­ing and data col­lec­tion.

“As a for­mer gover­nor, I’ve seen states in ac­tion and know what great lab­o­ra­to­ries they are for innovations we can put into prac­tice na­tion­wide,” HHS Sec­re­tary Kath­leen Se­be­lius said last week in a state­ment. Within the test­ing mod­els, the CMS will of­fer two tracks: one for those states that are ready to go and one for new mod­els.

Both sets of ap­pli­ca­tions are due by Sept. 17, and HHS ex­pects to an­nounce the grants in Novem­ber. The pe­riod of per­for­mance for the model de­sign awards will last from the time the award is granted through May 14, 2013, while the model test­ing awards al­low up to six months for im­ple­men­ta­tion and readi­ness and 36 months for test­ing af­ter the award date, or through May 15, 2016.

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