Medicare Initiatives Authorized by The Affordable Care Act

1. Medicare Initiatives Authorized by The Affordable Care Act Nancy B. O’Connor Regional Administrator October 25, 2012 Richmond, VA

2. Topics for Today • CMS Background • The case for patient-centered care • The ACA-arsenal of health home options • MAPCP • CPCI • Independence at Home • Medicaid Health Home • Accountable Care Organizations

3. About CMS Mission CMS is a constructive force and a trustworthy partner for the continual improvement of health and health care for all Americans. Largest health insurer in the country Over 100 million covered lives Over 1 million Medicare physicians 31 Medicare contractors Medicare/Medicaid/CHIP=$937 billion Top Priorities Keep the trains running Implement the Affordable Care Act Lead the improvement of health care in America New logo!

4. CMS’ Ten Regional Offices

5. The State of Health Care • Unsustainable • Escalating Costs • Excessive Services • ACA lays the foundation for transformation • Provide better care • Promote better health • Lower costs

6. Integrating Care Delivery • Incentives for Delivering Integrated Primary Care • Multi-payer advanced primary care demonstration • Comprehensive Primary Care Initiative • Independence at Home • Medicaid Health Home • Accountable Care Organizations • Medicare Shared Savings Program (MSSP • Pioneer • Advanced Payment

7. Multi-payer Advanced Primary Care Practice Model (MAPCP) • Medicare will participate in existing State multi-payer health reform initiatives that currently include participation from both Medicaid and private health plans. • The demonstration program will pay a monthly care management fee for beneficiaries receiving primary care from APC practices • Eight states selected to participate • By end of year 3, up to 1200 practices caring for ~900,000 beneficiaries

8. Comprehensive Primary Care Initiative • A major barrier to transformation in practice is transformation in payment • Will test two models simultaneously: Practice Redesign • Provision of core primary care functions • Better use of data Payment Redesign • PBPM care management fee • Shared Savings opportunity

9. Additional Health Home Models • Independence at Home • A payment incentive and service delivery model utilizing physician and nurse practitioner teams • Reduce preventable hospitalizations, readmissions, and ER visits • Improve health outcomes, and care efficiency • Medicaid Health Home • Option for all states – very flexible • Enhanced financial resources

10. ACO Models • Pioneer Model • Designed for organizations well on their way to changing their care delivery/business models • Advanced Payment Model • Gives certain ACOs access to up front shared savings • Medicare Shared Savings Program • Facilitate coordination and cooperation among providers

11. Lessons Learned • Getting to 5,000 assigned members • Coordination takes time • Physician champion are key to success • Reliable data partner/IT infrastructure for analysis • ACO management can drive provider conversation

12. Questions? Nancy.Oconnor@cms.hhs.gov 215-861-4140