Friday, May 24, 2013

Health Care Innovation Award Opportunity Announced

Under this announcement, CMS will spend up to $1 billion for awards and evaluation of projects from across the country that test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

Complete program details and application requirements may be found at: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Round-2.html

Key requirements, new developments and limitations of the latest round of funding have been bulleted below, courtesy of our partner, CIVHC:

- This round of awards is still strongly focused on payment models that will decrease the cost of care for Medicare, Medicaid and CHP, with particular emphasis on the last two programs. Applications for delivery system redesign that are not accompanied by fully developed payment models or model designs will not be considered. Funds will be directed towards programs that can improve the quality of care and deliver sustainable savings to CMS within three years.

· Proposals for $10 million or more must submit an external actuarial review of their financial plan.

· CMS is requiring demonstrated engagement (or commitment to engage) from multiple payers. Applicants are encouraged to look beyond fee-for-service or supplemented fee-for-service models, alternative payment methods will be given preference.

· Models based on acute hospital inpatient programs only will not be eligible for funding.

· The awards are designed to address gaps in programming from the last round of funding, organized into four categories. All proposals must address at least one category:

1. Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings.

2. Models that improve care for populations with specialized needs.

3. Models that test approaches for specific types of providers to transform their financial and clinical models.

4. Models that improve the health of populations – defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class – with activities focused on engaging beneficiaries, prevention, wellness, and comprehensive care beyond clinical service delivery.

There are priority groups within each category that are seen as high-need and/or cost-drivers; proposals addressing one or more priority groups will be given preference.

· Technology development is strongly encouraged and applicants who propose to develop open source technology to help in service delivery or payment efficiencies will be given preference.

· This round of funding is open to: provider groups, payers, states and local governments, faith-based organizations, convener groups, public-private partnerships and for-profit groups, etc.

The clear emphasis on payment models and sustainable cost savings over delivery redesign is especially important. While cost savings were required in the first round of Innovation Challenge awards, CMMI is emphasizing this still more in the second round. Note that that payment models must be developed and ready to implement in order for applications to be successful.

Awards for this round will range from $1-30 million (up to $900 million total) and will be awarded with an anticipated start date of April 1, 2014. CMS will be hosting informational webinars to help applicants understand the requirements; dates and topics will be announced mid-June.

· Letters of intent are due to CMS by June 28, 2013

· Full applications are due August 15, 2013.

· Awards will be announced January 2014.

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