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Striking Early

November 17, 2010
by Mark Hagland
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How the opening of CMS’s new Center for Innovation could be a win for everyone

The news yesterday that CMS had gotten its Center for Medicare and Medicaid Innovation up and running already, with a dedicated acting director and several projects to focus on, was both exciting and surprising. I have the strong feeling that Dr. Donald Berwick and others at CMS realized that the political climate in Congress would not be favorable after January 1, and that they acted quickly and decisively to open the Center for Innovation before anything political could happen to it.

And, judging by the four initial demonstration projects Dr. Berwick and Dr. Richard Gilfillan, the Center’s acting director, announced as their main areas of focus going forward, they’ve judged wisely and carefully. After all, who could object to those projects? They include: the creation of an eight-state primary care demonstration to stimulate medical home models; creation of a demonstration project for testing advanced primary care models based in community health centers; the development of a home health option for Medicaid enrollees; and the testing of new integrated care models for Medicare-Medicaid dual-eligibles, who remain among the most challenging patients to take care of effectively.

What’s more, the emerging literature on coordinated care seems to back up these efforts as well. For example, a September 14 Health Policy Brief in Health Affairs found that all seven medical home demonstration projects studied, including ones developed by such well-known pioneer organizations as Geisinger Health System, Group Health Cooperative, and Intermountain Health care—but also ones run by far less well-known provider organizations and alliances—realized significant returns on investment for their development work, including dramatic reductions in hospitalizations and ED visits, as well as significant savings per patient.

For example, Community Care of North Carolina’s long-term statewide project to better coordinate care for high-cost Medicaid patients led to a 40-percent reduction in hospitalizations, while a collaboration between MeritCare Health System and Blue Cross Blue Shield of North Dakota in that state, focusing on patient-centered medical home model in rural areas, resulted in a 24-percent reduction in ED visits and a savings of $530 per member per year.

Not surprisingly, the leveraging of clinical information technology figures strongly into some of these projects. For example, Intermountain’s use of electronic health records to improve care for at-risk patients and those with chronic diseases resulted in a $640-per-patient reduction in costs. These kinds of results speak to the tremendous potential when everyone, including IT leaders, comes together to improve patient care delivery and think outside of the box at a healthcare system level.

And if CMS’s new Center for Innovation can show strong results relatively early, it may be able to escape the landmine-laced field of Congressional politics and create an important win for healthcare reform before divisive politicians can even weigh in. And that would be great for everyone.

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Comments

Mark,
I greatly appreciate your post. You tied the reality of political expediency with the CMMI news event, and provided recent, relevant historical ROI data to substantiate the logic.

In reading your post, I'm wondering if you've written about the MediCare Physician Group Practice Demonstration project, and the ROI experience of it's participants. Although there's a great story about the Marshfield Clinic there, as Gail Willensky has pointed out in her recent ACO perspective in NEJM, most of the other participants, despite HCIT, struggled to demonstrate savings. What's your take?

Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...