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Monday, April 22, 2024

Medicare Tests Quality/Cost Initiatives

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The Centers for Medicare and Medicaid Services has launched pilot programs in Indiana and North Carolina to improve the delivery and quality of care to Medicare and Medicaid beneficiaries while lowering costs.

The Indiana Health Information Exchange will conduct the first large-scale Medicare study of a multi-payer, quality reporting and improvement, and pay-for performance program. Data from Medicare, Medicaid, private insurers and employer-sponsored health plans will be combined with clinical data to test if quality improvement and pay-for-performance programs are more effective in a multi-payer environment. About 800 providers treating the majority of Medicare fee-for-service patients in the Indianapolis area will participate.

The North Carolina Community Care Networks demonstration program will apply the “medical home” model through eight regional networks to low-income Medicare beneficiaries and those dually eligible for Medicare and Medicaid. The networks, comprising hospitals, community physicians, health departments and other organizations, will serve as a medical home or primary source of care for beneficiaries. The goal is to plan and assess the coordination of care, implement performance incentives and measure the quality of care.

The medical home model calls for redesigned practices that are more functional and workflow-friendly, and development of new processes to focus on quality, safety and alternative reimbursement methods. The care model also calls for extensive use of health information technologies, including electronic health records, e-prescribing, clinical decision support, secure messaging and Web portal software.

Both Medicare demonstration programs enable participating organizations to share in a portion of Medicare savings once they have achieved quality and cost objectives. For more information on the demonstration programs, click here.

-Joseph Goedert

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