The Center for Medicare and Medicaid Innovation: Its Purpose, Processes, and Desired Outcomes

Abstract

The intent of the Centers for Medicare and Medicaid (CMS) Innovation Center is to discover payment mechanisms for use by Medicare and Medicaid that will improve healthcare quality and reduce costs. Whether paying for primary care, hospital care, health systems care delivery, or state-based health care, the objective is to create a business context for innovation and to reward better quality and more efficiency. This context is intended to lead to a national healthcare system that improves the health of patients and the public and reduces total costs. In addition, in order for the fruits of the CMS Innovation Center to have impact as soon as possible, the ACA creates an opportunity that if a new payment approach reduces costs while maintaining or improving quality, it does not have to go through the usual Federal law-making process. Once the results are certified by actuaries, the evaluation can be brought to the Secretary of Health and Human Services who can make that payment approach national policy immediately. This is unique in the history of CMS and provides the opportunity to test and rapidly scale to a national implementation new payment approaches with the goal of improving quality and reducing costs. Since it began its work in 2011, the Innovation Center has mounted a wide array of programs in several key areas, including coordinated care (including primary and preventive care), episodes of hospital care, and coordination of care of those eligible for both Medicare and Medicaid. These efforts, which have the deep involvement of CMS and the healthcare industry, and the ability to implement successful innovations promptly, make the Innovation Center a very important part of the ACA for substantially improving health care in this country.