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March 27, 2018

Spring OPPS Update Released

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Medical Coding News Archives

The CMS Innovation Center

August 16, 2017:

In an effort to better control healthcare costs while simultaneously improving quality of care, payers and providers in the private sector, as well as government-funded plans, have been experimenting with a variety of value-based reimbursement models. A provision in the Affordable Care Act (section 1115A of the Social Security Act) established the CMS Innovation Center to assist with these efforts. The stated purpose of the CMS Innovation Center is to test “innovative payment and service delivery models to reduce program expenditures...while preserving or enhancing the quality of care” for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries.

With increasing emphasis on developing and implementing new value-based healthcare delivery and payment systems, a basic understanding of the goals and priorities of the CMS Innovation Center is needed, especially since the implementation of the Quality Payment Program (QPP) falls under its oversight. As stated on its website, the CMS Innovation Center is currently focused on the following:

  • Testing new payment and service delivery models, including QPP Advanced Alternative Payment Models (APMs)
  • Evaluating results and advancing best practices
  • Engaging a broad range of stakeholders to develop additional models for testing

The CMS Innovation Center has organized new payment and service delivery models into seven categories as follows:

  • Accountable Care
  • Episode-based Payment Initiatives
  • Primary Care Transformation
  • Initiatives Focused on the Medicaid and CHIP Population
  • Initiatives Focused on the Medicare-Medicaid Enrollees
  • Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
  • Initiatives to Speed the Adoption of Best Practices

These payment and delivery models are described in detail on the website. A helpful tool found on the website is a map where providers can identify the state-run and facility-run programs in their localities. There is also a link to the QPP webpages.

Review all of this information at https://innovation.cms.gov/

In addition, see the new offerings at Optum360 with information around QPP and other value-based purchasing resources:




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