The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to announce the following updates:

The Centers for Medicare & Medicaid Services (CMS), Medicare-Medicaid Coordination Office (MMCO) is pleased to announce the following updates: Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, Phase One CMS Innovation Center New Direction Request for Information Colorado Managed Fee-for-Service Demonstration Year 1 Medicare Savings Estimates Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (Phase One) On Friday, October 20th, CMS released the final independent evaluation report for the first phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, focusing on the 2014-2016 period. The report is posted here on the MMCO website: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/InitiativetoReduceAvoidableHospitalizations/Evaluation-.html The evaluation determined that all seven sites reduced hospitalizations, with six of the seven achieving statistically significant improvement in either all-cause hospitalizations, potentially avoidable hospitalizations, or both. Total Medicare expenditures were reduced in six of the seven sites, with statistical significance in four. If the intervention cost is taken into account, four of the seven sites achieved Medicare expenditure reductions in excess of costs, though overall the difference was not statistically significant. The report found the strongest improvements in both cost and quality at the intervention sites with a full-time nurse at each facility providing direct care to residents. These models demonstrated greater changes in facility culture, greater support for the need to reduce avoidable hospitalizations, and greater overall buy-in to the Initiative from facility staff, resulting in stronger intervention effects. Intervention sites where nurses did not provide direct care, or where nurses rotated across multiple facilities, showed less consistent effects. According to the report, “Overall, these findings provide persuasive evidence of the Initiative’s effectiveness in reducing hospital inpatient admissions, ED visits, and hospitalization-related Medicare expenditures.” The second phase of the Initiative, already underway, tests new payment reform models, both in conjunction with the Phase One interventions or on their own. CMS Innovation Center New Direction Request for Information The CMS Innovation Center (Innovation Center) recently issued an informal Request for Information (RFI) seeking feedback on a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. The Innovation Center welcomes stakeholder input on the ideas on additional ideas and concepts, and on the future direction of the Innovation Center. While existing partnerships with healthcare providers, clinicians, states, payers and stakeholders have generated important value and lessons, CMS is setting a new direction for the Innovation Center. To be assured consideration, please submit comments online or by email to CMMI_NewDirection@cms.hhs.gov through 11:59 p.m. EST November 20, 2017. Colorado Managed Fee-for-Service Demonstration Year 1 Medicare Savings Estimates On Friday, October 20th, CMS released the Colorado Demonstration Year 1 Medicare savings report, containing Medicare actuarial cost savings results of the Accountable Care Collaborative (ACC): Medicare-Medicaid Program (ACC:MMP) Managed Fee-for-Service model demonstration under the Medicare-Medicaid Financial Alignment Initiative.  The report is posted here on the MMCO website: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Evaluations.html CMS and Colorado launched the Colorado managed fee-for-service model demonstration in 2014. The demonstration leverages the State’s existing ACC program which, prior to the demonstration, did not include dually eligible beneficiaries. The ACC is a statewide primary health care program where the primary care medical provider (PCMP) serves as the medical home, and the Regional Care Collaborative Organization (RCCO) provides care coordination services to Medicaid populations. For more information about the Colorado demonstration, please see: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Colorado.htmll The report released today includes calculations of Demonstration Year 1 (September 2014 – December 2015) Medicare cost results for the Colorado demonstration. The calculations were performed by RTI International, the independent evaluation contractor for the Financial Alignment Initiative. The report indicates additional Demonstration Year 1 Medicare costs for the Colorado demonstration of $10,253,047, or $36.42 per member per month (PMPM). Results varied across sub-populations of beneficiaries. Nearly all of the estimated Medicare cost increases were driven by users of Home and Community-based Services (HCBS), whereas the demonstration achieved small savings among nursing facility residents and non-HCBS community residents, collectively. See Table 6H on page 36 of the report and Table 7A on page 39 for additional detail. RTI has not yet estimated Medicaid savings or costs due to lags in Medicaid data availability. RTI will include Medicaid savings analysis in future reports once data are available. The Colorado demonstration is the second for which Medicare actuarial cost analysis has been published. For the Washington demonstration, RTI found total gross Medicare savings of $67 million for the first two Demonstration Years (July 2013 – December 2015).

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