I was recently discussing all the changes going on in healthcare at a summer cookout with a few doctors in private practice. The topic of accountable care organizations (ACOs) came up, and the group started debating the pros and cons of them. At one point in the conversation, I brought up Medicare’s Innovation Center (the organization leading efforts like ACOs) and asked the group what they thought of it. No one knew what I was talking about.
To be honest, I didn’t know much about the Innovation Center until recently and wouldn’t criticize anyone who doesn’t know much about it. But as doctors, we should all know about the Innovation Center because it is the body behind some of the largest and possibly most impactful changes in healthcare delivery. What the Innovation Center does will no doubt affect how doctors practice.
I learned more about the Innovation Center when I prepared a piece for the New England Journal of Medicine that was published this spring and want to share some of the insights from that work.
The Innovation Center, officially known as the Center for Medicare and Medicaid Innovation (CMMI), has a $10 billion budget over nine years (2011 to 2019). Its goal is to reduce costs for Medicare and Medicaid while preserving quality. To date it has launched over 25 programs in the following six domains:
- Accountable care: ACOs, programs for home healthcare and end-stage renal disease.
- Episode-based payment: also known as bundled payment for services such as joint replacement and oncology care.
- Primary care transformation: programs to remodel primary care and improve coordination.
- Medicaid and CHIP: programs focused on state-run Medicaid and CHIP such as efforts to improve emergency mental healthcare and prenatal care.
- Other payment innovations: a key program in this domain is the Maryland All Payer Model where hospitals aim to control costs for all payers, not just Medicare.
- Adoption of best practices: key programs in this domain are the Million Hearts Initiative to reduce cardiovascular risk and the Partnership for Patients to reduce readmissions and hospital-acquired conditions
A few key things to consider about the Innovation Center:
1. The number and breadth of initiatives that the Innovation Center runs is enormous. This could be a good thing or a bad thing. On the one hand, almost everyone would agree that there is room to improve healthcare delivery. The Innovation Center has an opportunity to test many options. On the other hand, this may lead to lack of focus and too many initiatives all at one.
2. Change is inevitable. Recently, the Secretary of Health and Human Services said that the goal is to have 50 percent of Medicare payments to shift away from traditional fee-for-service payment to value-based models such as payments under the ACO model and other models.
3. There are challenges. Leaders from the Innovation Center recently outlined a few challenges they foresee including difficulty measuring quality, challenges in evaluating the impact of the programs, and general challenges of changing systems and behavior
4. But the Innovation Center controls one of the most powerful ways to reform healthcare. It has the ability to change payment structures in Medicare which may prove to be an incredibly powerful tool for systems and behavior change.
It’s hard to predict how things will evolve for the Innovation Center. Some programs will succeed, and some will fail. The Innovation Center seems committed to expand successful programs and terminate unsuccessful ones. I personally think this is a big change for government sponsored healthcare – trial and error and learning from experience are okay.
For the physician community, the successes and failures of the Innovation Center’s programs will undoubtedly impact us and it’s worth knowing what the Innovation Center is doing.
Tara F. Bishop is an internal medicine physician who blogs at her self-titled site, Tara Bishop MD.
