The Center for Medicare and Medicaid Innovation (CMMI or the “Innovation Center”) was established under the Affordable Care Act (also known as “Obamacare”) to test “innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing the quality of care” for individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.

The Innovation Center provides a mechanism to test models that improve care, lower costs, and better align payment systems to support patient-centered practices. In particular, the center prioritizes models that either (a) reduce spending without reducing the quality of care or (b) improve the quality of care without increasing spending – and that do not deny or limit the coverage or provision of any benefits.

With respect to process, the Innovation Center is positioned to evaluate the current reform efforts widely used in the private sector and develop provider-proposed approaches that rapidly adjust models in response to feedback from clinicians and patients.

The Innovation Center also plays a critical role in implementing the Quality Payment Program, created by Congress as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to pay for physicians’ and other providers’ services. Under this program, clinicians can earn incentive payments by participating in Advanced Alternative Payment Models (APMs). In APMs, clinicians accept some risk for their patients’ quality and cost outcomes and are required to meet specified quality metrics, consistent with CMS’s belief that transitioning to value-based payment systems that reward quality and lower costs is essential to improve and maintain sustainability.

Since the launch of CMMI, health policy leaders on Capitol Hill and across federal agencies have encouraged ACCP to explore opportunities within CMMI to integrate CMM within evolving Medicare AMPs endorsed by both Congress and CMS.

Comprehensive Primary Care Plus
Within the Innovation Center, Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally based multi-payer payment reform and care delivery transformation. Currently, almost 3,000 primary care practices participate in CPC+ across 18 regions. CMS’s updated program for participating CPC+ practices requires that practices develop a plan to provide CMM to patients discharged from the hospital and those receiving longitudinal care management.

USC CMMI Comprehensive Medication Management Program
In 2012, the University of Southern California (USC) received a $12 million grant from CMMI as part of an initiative to integrate pharmacists’ services into safety-net clinics in Southern California as a way to improve medication adherence and safe and appropriate use of prescription drugs, with the intended result of optimizing patient health while reducing avoidable hospitalizations and emergency visits. Click here for more information on the USC/AltaMed CMMI Project.

Next Steps
These examples of efforts within CMS to integrate pharmacists’ services across a variety of team-based settings demonstrate the growing recognition of medication optimization as an essential professional activity for effective, integrated primary care. Given the central role of medications in the care and treatment of older adults with chronic conditions, combined with the continued growth in the range, complexity, and cost of medications, maximizing the benefits offered by medications in improving outcomes is critical to the success of the patient-centered medical home (PCMH).

ACCP’s Washington office goes well beyond its established efforts on Capitol Hill to educate lawmakers about coverage for pharmacists’ services. Through ventures like GTMRx, the team can now devote resources to support the advancement of clinical practice across multiple payers and settings.

ACCP’s engagement with CMMI staff to date demonstrates that they share our goal of medication optimization for Medicare beneficiaries and that CMMI is an appropriate venue to advance models to pilot these emerging practices. We continue to work with our members to support the Innovation Center’s ongoing efforts to advance medication management services.

Building on this progress, ACCP is exploring opportunities to initiate a broader CMM pilot within the Innovation Center that might eventually pave the way for the full integration of a CMM benefit within Medicare APMs. We will continue to keep our members updated as this exploratory work continues!

ACCP members who are currently engaged in practices participating in CMMI or who are interested in doing so are encouraged to reach out to our Professional and Government Affairs team to discuss opportunities to highlight these innovative practices as part of our broader advocacy efforts.