By Susan Jaffe
Don’t look only to Washington policymakers for strategies to control medical costs and improve care for our aging population. New pilot projects that could accomplish these goals, which are at the heart of Health Policy, are being tested in communities across the country.
As provided under the Affordable Care Act, these experiments are intended to find solutions to daunting care delivery and payment problems in Medicare, the $563 billion federal health program for 48 million older and disabled Americans.
To oversee these projects, the health law created the Center for Medicare and Medicaid Innovation within the agency that runs Medicare, the U. S. Centers for Medicare and Medicaid Services. According to the Innovation Center’s progress report (PDF) published earlier this year, “Its mission is to move quickly to identify, test, and spread delivery and payment models to help providers improve care while cutting costs.”
The Innovation Center has approved dozens of pilots launched by hospitals, physicians, other provider and community groups. Here are some highlights, along with information about where to find them:
Community-based Care Transitions Program
Medicare spends about $12 billion each year on hospital readmissions that could be avoided, according to estimates from the non-partisan Medicare Payment Advisory Commission. This pilot project provides $500 million for grants to community organizations and hospitals to test ways of reducing the number of patients who re-enter the hospital within 30 days of being discharged. These collaborative efforts are underway in AR, AZ, CA, CT, DE, GA, IL, ME, MA MI, NE, NY, OH, PA, TX, and WA.
Comprehensive Primary Care Initiative
Under this $322 million, four-year initiative, and primary care physicians will be eligible for bonus payments from Medicare, Medicaid and commercial insurers for improving care for patients with multiple chronic health problems. Interventions might include round-the-clock access to medical providers, personal care plans and caregiver assistance. Physicians will share savings if medical costs are reduced. The Innovation Center has selected statewide initiatives in AR, CO, NJ, OR, and parts of NY, OH, and OK. About 75 primary care practices will be selected to participate. In June, the Innovation Center announced that 44 health insurance plans have joined pilot project.
Health Care Innovation Awards
Unlike other pilot projects, this one is structured like a contest seeking the best ideas for improving health care for specific Medicare, Medicaid or CHIP patients or for workforce development and training. All pilots need to be able to start or expand within six months. Nearly 3,000 applications were submitted and 107 projects have been selected from all 50 states and the District of Columbia and are expected to save an estimated $1.9 billion.
Independence at Home Demonstration Project
Medical teams of physicians, nurses, pharmacists, and social workers will test whether providing medical care in patients’ homes can reduce hospital admissions, improve health and lower Medicare costs. Eligible patients must have multiple chronic conditions, need help with bathing, eating, dressing or other daily activities and have undergone a recent stay in the hospital. The three-year, $15 million project began in June. Sixteen medical practices in DE, FL, GA, KY, MA, MI, NC, NY, OH, OR, TX, and WI will be the first to participate.
Innovation Advisors
The Innovation Center chose 73 individuals out of 920 applicants to help spur delivery system reform in their communities and provide expertise in health care finance, health system analysis and other specialties. The consultants started work in January 2012 and are based in CA, CO, DC, DE, GA, KY, HI, IA, IL, LA, MA, MD, MI, MN, NC, NH, NY, OH, OR, PA, RI, TN, TX, UT, VA, WA, WI, and WY. Their names and affiliations are available online.
Pioneer Accountable Care Organizations (ACOs)
Accountable care organizations (ACOs) are group of physicians, hospital and other providers that join together to provide high quality, coordinated medical services and assume financial risk for doing so. Instead of being paid separately for each service, ACOs test new models of payment that depart from the fee-for-service payment system. There are several types of ACOs, each with a slightly different twist. The Pioneer ACOs participants have experience in care coordination and will work private insurance companies. [unlike MSSP ACOs below, which are part of Medicare fee-for-service ] In December, the Innovation Center named 32 “Pioneer ACOs” at health care systems in CA, FL, IL, IN, MA, MI, MN, NM, NY, NE, PA, TX and WI.
Another type of ACO is already a permanent part of Medicare, within the Medicare Shared Savings Program (MSSP). The first group of 27 MSSP ACOs was announced in April. In July, another 89 MSSP ACOs were selected in 40 states and the District of Columbia. This brings the total number of ACOs to 154, serving more than 2.4 million beneficiaries, including the Pioneer ACO pilots.
Story pitches and questions to ask
Each of these pilot projects is newsworthy and offers a local angle to a national story as well as good opportunities to develop sources. These stories could run as features, business or metro news. Here are just a few story ideas:
Business stories:
- What new or existing local businesses, medical suppliers, as well as medical institutions are participating? How does participating in the project change their business model? How will success or failure affect their business prospects ?
- What happens when the grant money runs out?
Feature stories:
- How are patients affected? How does it feel to be part of an experiment?
- Profile the person who spearheaded the successful application; what obstacles did he or she overcome?
Metro news stories:
- Local doctors’ practices, hospital system, social service agency (or all of the above) receive millions of dollars in federal funds to help find a solution to the nation’s health care crisis.
- What is the track record of grant recipients? Are they qualified to carry out their project? Check Medicare’s hospital and doctor compare websites for ratings, state licensure boards and perhaps online court records. See other AHCJ resources for tips on how to investigate hospitals and other medical providers.
- Who’s left behind? Were better qualified, more established groups rejected or did they decide not to compete? To respect applicants’ privacy, the Innovation Center will not reveal the names of applicants for upcoming grants until awards are issued and will not disclose organizations that were rejected, said spokeswoman Kathryn Ceja, a spokeswoman. Perhaps if enough reporters are interested in this information, this response will change.
Health:
- How will a physician practice or hospital participating in one of these projects measure success? Can those results potentially be applied elsewhere or they based on a limited experience of certain kinds of patients?
- Are pilot projects a good way to develop effective approaches save health care dollars improve care? A recent report from the non-partisan, independent Congressional Budget Office (see information resources below), found that 10 past demonstration projects did not produce lasting changes or save money.
- Déjà-vu? Are the winning pilot projects really new? Are they testing approaches that already exist or were tried and abandoned?
- What happens when the grant money runs out?
- Do opponents of the health law also oppose these pilot projects? Have grant recipients or would-be recipients lobbied or their professional organizations elected officials to support or oppose the health law?
- Why didn’t some prominent local medical institutions or community organizations get grants even though they would appear to be strong candidates for these awards (based on their track record)? If they applied, why were they rejected? Can they implement their project without federal support? (See last item in previous section.)
- These pilot projects often provide special benefits to participating patients. Of the grants distributed so far, has your state or region been left out? Why?
For more information:
Center for Medicare and Medicaid Innovation
“One Year of Innovation, Taking Action to Improve Care and Reduce Costs,” U. S. Centers for Medicare and Medicaid Innovation, January 2012 (includes three-page chart of current and future pilot projects)
“The Center for Medicare and Medicaid Innovation: Activity on Many Fronts,” Robert Wood Johnson Foundation and the Urban Institute, Robert A. Berenson and Nicole Cafarella February 2012
“Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment,” Congressional Budget Office January 2012
Tell us about your story
If you write about any of these projects contact us so that we can mention them here. Also, let us know if you encounter obstacles while reporting.
Susan Jaffe is a Washington, D.C.- based reporter specializing in health policy and aging issues and a regular contributor to Kaiser Health News. Her work has appeared in USA Today, The New York Times, The Washington Post, The Center for Public Integrity and other outlets.
