Health Care Innovation Challenge

1. Health Care Innovation Challenge Funding Opportunity through Center for Medicare and Medicaid Innovation Announced November 14, 2011

2. Measures of Success • Better Health Care (Improve individual patient experiences of care along the IOM 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity) • Better Health (Focus on the overall health outcomes of populations by addressing underlying causes of poor health, such as: physical inactivity, behavioral risk factors, lack of preventive care, and poor nutrition) • Reduced Costs (Lower the total cost of care for Medicare, Medicaid and CHIP beneficiaries by improving quality of care and patient experience)

3. Objectives of Initiative • Engage a broad set of innovation partners to identify and test new care delivery and payment models that originate in the field and improve quality while lowering the total cost of care. • Identify new models of workforce development, training and deployment that support new models either directly or through new infrastructure activities. • Support innovators that can rapidly deploy care improvement models within six months of the award through new ventures or expansion of existing efforts.

4. Service/Payment Delivery Model • Focused on innovative approaches to improving health and lowering costs for high risk/high opportunity populations • Multiple chronic diseases and/or mental health or substance abuse issues • Poor health status due to socio-economic and environmental factors • Multiple medical conditions • High costs individuals • Frail elderly

5. Health Care Workforce of the Future • Focused on prevention, care coordination, care process re-engineering, dissemination of best practices, team-based care, community-based care, continuous quality improvement, and the use of data to support new care delivery models. • Examples… • Personal and home care aides to help the elderly age at home • Expanding the use of community based paramedics to provide basic services to extend available primary care resources in rural communities • Community based nurse teams working with primary care practices to provide intensive care management for the most complex patients

6. Enhanced Infrastructure is Critical • Infrastructure is necessary to support effective and efficient system-wide function and the rapid diffusion of best practices • Examples… • Broad implementation of registries • Data intermediaries for quality reporting and information sharing to support care coordination • Preventive care models • Telemedicine and remote monitoring models, medication reconciliation systems, share-decision making systems • Innovation or Improvement networks • Community Collaboratives

7. Key Attributes • Workforce Development and Deployment • Need to identify and test new ways to create the workforce of the future that will deliver and support new care models. • New roles and skills for existing health professionals • New types of workers to support care transformation • Team-based models to better utilize a mix of health providers

8. Key Attributes • Speed to implementation • Proposed models should be operational and capable of rapid expansion or sufficiently developed to be rapidly deployed. • Proposals will be expected to deploy care improve-mentmodels within six months of the award. • Training programs are eligible for funding but should be intensive, brief programs connected to the model being tested.

9. Key Attributes • Sustainability: proposed models are expected to • Define and test a clear pathway to ongoing sustainability. • Inform future benefit design and/or payment approaches for CMS consideration and • Provide recommendations for the scaling and diffusion of the proposed model. • Preference will be given to proposals that can achieve sustainability as soon as possible within three years. • Examples: public-private partnerships, multi-payer approaches, proposed service delivery agreements with entities such as ACOs or Advanced Primary Care models, mental health/public health systems.

10. Awardees will be selected based on the following criteria… • Model design: proposes an innovative approach to achieve better care, better health and lower costs • Organizational capacity: demonstrates a history of operational success and realistic plans for implementation • Workforce: demonstrates significant workforce impact • Sustainability and finances: offers a pathway to sustainability and lowers cost • Evaluation: Plans for self-evaluation to assess achievement of the three-part aim

11. Important Information • Awards expected to range from $1 million to $30 million ($1 billion total). • States are not eligible to apply as awardees. • Preference given to projects that implement activities faster than six months. • Specific interest in new roles and skills for existing health professionals, new types of workers to support care trans-formation, team-based models to better utilize a mix of health providers. • Workforce expansion is key: quick training and implementation (< six months).

12. Key Dates • December 19, 2011: letter of intent • January 27, 2012: application due • March 30, 2012: awards granted to selected applicants (Two planned award cycles—March and August) • Three years from award date: end of period of performance

13. Ideas for Montana…. • Frontier community health integration project • Model already exists • Spread to all frontier hospitals • Community health workers trained, utilize community paramedics • Community Paramedics • Medical Home Model • Lean engineering • Dental • Career pathways displaced workers • Telemedicine • Tribal programs • HIT—EMR/EHR