Innovation with Integration- Healthcare in 2012

A top Google Executive recently inferred that the United States can regain its economic footing by being the global leader for innovation. This innovation focus directly relates to the innovation and integration themes that are driving the 2012’s Federal healthcare initiatives. Specifically, Centers for Medicare and Medicaid Innovation’s (“CMI”) focus is to test innovative ideas and unique models to improve patient care for population health at a lower cost. In order to spawn innovative ideas, CMI constantly funds and supports models that use innovation to change how healthcare is delivered.

Just in the last two months, CMI announced $2 Billion in additional funding for innovative programs that will be implemented in early 2012. $1 Billion was allocated for grant funding. The grants may be awarded to either for-profit or nonprofit organizations or collaborations that meet the objectives of the program. Specifically, the Healthcare Innovation Challenge will provide grants in the range of $1 Million to $30 Million to individuals, entities or collaborations that use innovation to provide healthcare in a unique manner that reduces costs and improves patient outcomes. The innovative model must be readily deployed within six months and sustainable within three years. Likewise, programs that provide workforce training to providers involved in the new models of healthcare delivery are also eligible. Thus, in order to drive change, CMI is offering financial support to a wide range of recipients that have concepts or models that can be developed and deployed quickly to impact the healthcare delivery system.

Second, in December, CMI announced another $1 Billion investment for Hospital Engagement Networks (HEN) and Community Based Care Transition Programs (CCTP). $218 Million was provided to 26 HEN programs that focus upon improving patient care, patient engagement and reducing hospital acquired conditions. HENs are directed to research hospital processes and to identify solutions to reduce hospital acquired conditions and replicate the successful solutions within other hospitals. HENs will focus upon patient safety initiatives, setting quality measurement goals and providing innovative tools to track and support improvement within the hospitals.

The other area of high cost to the healthcare system is the readmission of a patients or duplicate tests performed when healthcare providers do not communicate with one another or the patient. In order to tackle the unnecessary readmissions and to improve clinical care coordination between different providers, CMI is providing up to $500 Million to CCTP. CCTP will identify best practices of coordinating care for high risk frail patients among providers in a community while engaging the patient through the new innovative process.

Likewise, CMI recently announced the 32 Pioneer Accountable Care Organizations (Pioneer ACO) that were awarded participation in the program. The 32 Pioneer ACO providers will utilize patient centered protocols to deliver care to the patients while reporting on quality metrics. If the integrated providers, through this Pioneer ACO, can reduce the cost of care that is delivered to these Medicare beneficiaries in comparison to previous years’ costs and achieve quality thresholds, the providers may be eligible to receive a share in the amount of money that they save the federal government.

All of the CMIs programs are attempting to persuade individuals and entities to develop innovative ideas to change how healthcare is delivered and paid for in the United States. These innovative models may be the potential solution for a lot of the different processes that drive the cost of the Medicare and Medicaid programs today. However, the models must be tested and reviewed before wide-spread expansion can occur. In order to prepare for the upcoming changes, providers should focus upon the premises of the CMI programs and evaluate how their current organization can use these themes as a foundation for delivering care in 2012.

Specifically, 2012 will likely focus upon the patient being the center of the healthcare delivery model. In addition to the patient, the community of providers that coordinate and deliver the care to the patient will be encouraged to clinically and/or financially integrate. Providers should expect innovative models that use information technology to expand in 2012 and ultimately to become part of the fabric of healthcare. Accordingly, as providers strategically focus upon 2012, they should (i) not lose sight of CMI and its programs, (2) be prepared to engage in new methods to communicate with patients; (3) be prepared to integrate services and clinical care with other providers in the community; (4) be prepared for the payment models to force integration with other providers; and (5) anticipate that additional quality measures and sharing of information will be required. While transparency was a key theme in 2009 and 2010, innovation and integration are the themes that are driving 2011 into 2012.

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