At CMS Innovation Workshop, care teams lead the way

Simple solutions to complex problems can change entire industries. This is true in healthcare just like it is true in manufacturing, retail, and telecommunications. Every industry can be disrupted. But how does it actually happen?

ACT.md is betting on the power of teamwork. We believe that high-performing teams made up of professionals who can manage all aspects of a patient’s health will disrupt the way care is delivered in the most dramatic and positive way possible. At the Regional Innovation Workshop held by the Centers for Medicare and Medicaid Services (CMS) this week, we were inspired to see again that care teams are ready, willing and able to take on this challenge.

This workshop — the first in New England, and just the third such event held across the country — brought together innovators from diverse organizations across healthcare. Ray Hurd, CMS Regional Administrator for Boston/New York, underscored the importance of this collaboration in his welcome remarks. He also introduced the first speaker, Rocco Perla, Director of Improvement Dissemination and Model Expansion at the Center for Medicare and Medicaid Innovation (CMMI). Rocco discussed the Center’s portfolio of innovation efforts and their three focus areas:

  1. Testing and expansion of alternative payment models, such as accountable care, advanced primary care, and bundled payments.
  2. Supporting providers and states to improve the delivery of care, through state innovation models and health care innovation awards.
  3. Increasing information available for effective informed decision-making by consumers and providers, using CMMI engagements to share best practices with providers.

With so many innovation demonstrations underway, what is shaping up as the biggest opportunity for CMS to improve outcomes and reduce costs? According to Rocco, demonstrations focused on helping teams manage care coordination across the continuum are the “crown jewels” in the CMMI portfolio and the ultimate purpose of CMMI’s experimentation with new payment models — proving yet again that high-performing care teams have the most potential to do the most good.

Other speakers at the workshop represented the innovation community’s “boots on the ground” and spoke about how their teams are improving care and reducing costs:

  • Catherine Fabrizi, RN, MSN, GNP-BC is the Nursing Director for Geriatrics at Boston Medical Center. Her team is participates in the “Independence at Home” demonstration initiated by the Affordable Care Act to improve outcomes and reduce costs for Medicare enrollees who are homebound, chronically ill and functionally dependent. These traits make this population readmission-susceptible, and Catherine’s team implements nurse case management with home care tactics in order to reduce ED and hospital utilization and readmissions. This national program has achieved over $25 million in Medicare savings.
  • Lisa Kippax, Care Transitions Program Manager for the Central MA MetroWest Transitions in Care Collaboration. This collaboration is dedicated to improving the experience and quality of care for patients, while reducing health care costs, as they transition from the hospital to the community. To date, the program has made significant progress towards its goal of achieving a 20% reduction in all-cause readmissions.
  • Andy Grigorov, a project lead in the Massachusetts Executive Office of Elder Affairs. Andy presented the Community Links Portal, a tool used by aging services organizations to share patient information with medical professionals. The tool is used by nearly 4,000 healthcare professionals in the state and contains information about 785,000 consumers.

William Kassler, MD, MPH, Chief Medical Officer for CMS Region 1, was the workshop’s final speaker. Much like his article in the New England Journal of Medicine earlier this year, Bill’s talk focused on CMS’s role in improving population health. As the nation’s largest payer, CMS also has a responsibility to consider the most successful ways to improve population health.

Bill highlighted research done by Elizabeth Bradley at Yale that shows that clinical care is responsible for only 20% of total health outcomes. Physical environment, health behaviors and social and economic factors together influence our health to a far greater magnitude than clinical care alone. Far too few healthcare dollars are spent on upstream interventions, so CMS will prioritize payments for programs that address social and behavioral determinants of health. This is great news for the healthcare innovation community and the industry as a whole.

Care teams recognize this is the right work to do, and they’re showing great results from innovative models in demonstration projects. We can scale these projects nationally with technology like ACT.md. The catalyst for system-wide change will be when CMS and other payers align the financial incentives for teams to succeed over the long haul.