Transforming Payment & Delivery

July 17, 2017

You know the old saying, “the only constant in life is change?” This is especially true in health care where reform and technology bring constant change (e.g., PQRS, VBM, MU, MACRA, MIPS, and APMs). Constant change and endless, complicated acronyms.

This post incorporates a little of both as we highlight Telligen’s work with the CMMI.

What is the CMMI?

CMMI, or the Centers for Medicare & Medicaid Innovation Center, was created as part of the Affordable Care Act to transform the fee-for-service health care system into one that offers coordinated care at higher-quality and lower-cost. Sounds easy, right? It’s obviously not, and that’s where we come in.

Telligen/CMMI By the Numbers:

  • CMMI contracts employ 210 Telligen employee-owners
  • Telligen holds 19 CMMI contracts spanning 6 out of the 7 Innovation Center categories
  • Employee-owners test new payment models designed to improve care, reduce costs, and create a sustainable future for Medicare
  • Click here for more on results and impact

What We Do, And Where We’re Doing It:

Telligen lends its clinical and technical expertise to multiple CMMI projects supporting the development and testing of new health care payment and service delivery models. Broadly speaking, those models fall into three categories: population-based payment (accountable care organizations and primary care medical homes), episode-based payment models (bundled payments), and other models focused on specific types of providers and/or patients. Here are few CMMI projects Telligen employee-owners currently support.

Project ACHIEVE (Achieving Patient-Centered Care & Optimized Health in Transitions by Evaluating Evidence)

  • Background: Study analyzing transitional care strategies with the goal of developing post-hospital best practices.
  • Our role: Develop provider/facility survey instrument, conduct site visits & data analysis consulting.

ACO Program Analysis & Operational Support (Accountable Care Organization)

  • Background: Program using ACOs to facilitate provider coordination, improve quality & reduce costs.
  • Our role: Assist with measures selection & specifications; provide technical assistance, & audit quality data.

Pioneer ACO

  • Background: Payment & delivery model designed to improve outcomes & achieve cost-savings for Medicare.
  • Our role: Assist with design & development of a quality reporting tool that supports the model.

Bundled Payment Care Initiative

  • Background: A Medicare payment reform demonstration designed to improve care quality & coordination & lower costs.
  • Our role: Offer subject-matter expertise related to collection & analysis of qualitative & quantitative data.

CICDIM (Consolidated Innovation Center Development & IT Management)

  • Background: The CMS Innovation (CMMI) Center supports development of new payment & delivery models.
  • Our role: Business analysis, quality assurance & development across current & future CMMI initiatives.

CPC (Comprehensive Primary Care)

  • Background: Medicare Initiative bringing together public & private payers to improve care delivery.
  • Our role: Offer support & subject-matter expertise related to quality, attribution, operations, technical support & participation management.

CPC+ (Comprehensive Primary Care Plus)

  • Background: Scaled-up version of the original CPC to include 5K additional practices.
  • Our role: Support practices & payers through program design & operations subject-matter expertise.

Evaluation of CJR Model (Comprehensive Care for Joint Replacement)

  • Background: Tests bundled payment & quality measurement for care episodes related to hip & knee replacements.
  • Our role: Primary data collection & operational support; data analysis & reporting.

Oncology Care Model

  • Payment & delivery model designed to improve care for beneficiaries receiving chemotherapy.
  • Our role: Centralized support related to quality measures, feedback reports, site visits & monitor claims data.

Reducing Avoidable Hospitalizations Among Nursing Facility Residents

  • Background: Effort to improve quality of care for nursing facilities by reducing avoidable hospitalizations.
  • Our role: Support site assessments & data collection; facilitate a results-oriented learning community.

Transforming Clinical Practice PTN (Practice Transformation Network)

  • Background: Initiative to achieve large-scale practice transformation across six states & 7K clinicians.
  • Our role: Support initiatives that improve quality of care for Medicare beneficiaries in Iowa, Illinois, & Colorado.
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