1/30/14 CMS released interim financial results for various initiatives that CMS is testing to improve the quality of health care delivery, while lowering costs through select Medicare Accountable Care Organization (ACO) programs. In an effort to reform the health care delivery system, ACOs are designed to achieve cost savings over several years. More than 360 ACOs, serving over 5.3 million Americans with Medicare, have been established since the passage of the ACA in 2010.

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve to help ensure that patients, especially the chronically ill, get appropriate care, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more efficiently, it will share in the savings it achieves for the Medicare program. According to the CMS report, savings from the Medicare ACOs, including the established Pioneer ACOs, exceed $380 million.

The Pioneer ACO model is designed for more experienced organizations prepared to take on greater financial risk. The CMS report shows that Pioneer ACOs, authorized by §3021, generated gross savings of $147 million in their first year. These savings far exceed findings from a previous analysis conducted by CMS, which used a different methodology.

Another initiative authorized by §3021 is the Bundled Payments for Care Improvements initiative, which bundles payments for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement. This is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients, both when they are in the hospital and after they are discharged.

CMS also released financial outcomes for the Physician Group Practice Demonstration, which offers incentive payments for delivering high-quality, coordinated health care that generates Medicare savings. This report confirmed overall savings totaling over $108 million over the 5 year experience with 7 out of 10 physician group practices earning shared savings payments for improving the quality and cost efficiency .

To learn more about the Medicare Shared Savings Program visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram

To learn more about Pioneer ACOs visit:

http://innovation.cms.gov/initiatives/Pioneer-ACO-Model/index.html

To learn more about the Bundled Payments for Care Improvement initiative visit: http://innovation.cms.gov/initiatives/bundled-payments

To learn more about the Physician Group Practice Demonstration visit: http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/Medicare-Demonstrations-Items/CMS1198992.html

Commonwealth of MA News

On January 14, 2014, the Massachusetts Executive Office of Health and Human Services, submitted a grant application for "Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare-Medicaid Enrollees" to the US Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) under ACA §3021.The proposal's title is "Duals Ombudsman Program Support: Massachusetts One Care Demonstration."

If awarded, this grant will provide funding to increase the capacity of the ombudsman program for One Care: MassHealth plus Medicare. One Care is an option for approximately 90,000 dual eligible individuals ages 21-64 to receive integrated, coordinated Medicare and MassHealth benefits through a health plan contracted with both the Commonwealth and CMS. The funding provided through this grant opportunity will enable the One Care Ombudsman (OCO) to increase its capacity to provide geographically and linguistically accessible services through a Regional Ombudsman and a Bilingual Ombudsman. The OCO will also develop accessible, multi-media educational materials on Medicare/Medicaid beneficiary rights, designed to empower individuals with knowledge and strategies to advocate for their rights in One Care. In addition, based on year one experience, the OCO will identify subpopulations with unmet ombudsman service needs, and launch a targeted program expansion. Finally, this proposal will extend full financial support for the OCO through December 31, 2016. 

Read the project abstract at:

http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/grants/140414-sec-3021-one-care-demo.pdf

The Executive Office of Health and Human Services (EOHHS) plans to submit to the Centers for Medicare and Medicaid Services (CMS) by March 31, 2014 two State Plan Amendments (SPAs) authorizing MassHealth's two Alternative Benefit Plans (ABPs) under the Affordable Care Act. EOHHS will accept comments on the proposal contained in the summary linked below through 5:00 pm on February 21, 2014.

A summary of the proposed SPAs and information about how to submit comments are available at: http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/alternate-benefit-plans-public-notice.pdf

Friday, February 21, 2014, 1:00-3:00 PM

State Transportation Building, Conference Room 1-3

10 Park Plaza

Boston, MA

We welcome attendance from all stakeholders and members of the public with an interest in One Care. Reasonable accommodations will be made for participants who need assistance. Please send your request for accommodations to Donna Kymalainen at Donna.Kymalainen@state.ma.us.

Friday, February 28, 2014

11:00 AM-1:00PM

1 Ashburton Place, 21st Floor

Boston, MA

MBTA and driving directions to 1 Ashburton Place are located here: www.mass.gov/anf

A meeting agenda and any meeting material will be distributed prior to the meeting.

Meetings of the Implementation Council are open to stakeholders and members of the public with an interest in One Care. Reasonable accommodations are available upon request. Please contact Donna Kymalainen at Donna.Kymalainen@umassmed.edu to request accommodations.