“Applications will be open to providers, payers, local government, public-private partnerships, and multi-payer collaboratives,” the CMS “Innovation” project said. “The Health Care Innovative Challenge will encourage applicants to include new models…to support their service delivery model proposal. All proposals “must be operational or capable of rapid expansion within six months.”
Awardees “will provide regular updates” on their progress and data to CMS. “CMS will also collect from awardees a standard minimum set of performance indicators through its monitoring and coordinating contractors” — federal “check-up” workers.
In other words, CMS will hire more people to act as “independent entities to assist in monitoring the programs…” That means piling on more employees. Create jobs at any cost seems the objective. “Awardees will also participate in learning sessions about how health care delivery organizations can achieve performance improvements quickly and effectively.” Apparently in the way bureaucrats have shown their remarkable prowess in “working effectively.”
The Innovative Center said it has received ideas from many including the Pioneers Accountable Care Organization model.
As the Disease Management Care Blog (DMCB) said earlier this year, “the Shared Savings Program’s Accountable Care Organization (ACO) model is likened to an Edsel, ‘widely considered one of the worst cars of all time.’”
The Disease Management Care Blog updated a parallel ACO program launched by the CMMS Innovation Center on May 17 dubbed “Pioneer.”
This three to five year Pioneer ACO Program is tailored to fast-track health providers organizations that already have care coordination programs up and running to what the Feds believe is the next level: ACO status. During the first 2 years, the candidate organizations will operate under a shared savings arrangement. If successful, payments will transition, as the DMCB understands it, to a “population-based payment model” that involves a mix of capitation and fee-for-service reimbursements.
Other insurers also have to join in and the number of their patients has to comprise more than 50% of the total. Much of the payment details are being left intentionally vague so that CMS can be flexible, it said.
At least 15,000 Medicare beneficiaries (or, if rural, 5000) have to be available in order for an organization to participate in Pioneer. While the default is to assign patients prospectively, the organizations can ask for retrospective assignment. Patients will not be locked into any network.
In the application process, these ACOs will also need to document how they are prepared to meet the needs and preferences of their patients with “patient centered care.” Patients will be notified that they can call a 1-800 number with any concerns. The Innovations Center hopes 30 programs will eventually participate.
And so the bureaucracy builds and jobs are made, despite there’s only borrowed money to pay for them.
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