CMS Earmarks $840 Million to Encourage Practice Transformation Networks

To help clinicians rethink and redesign their practices by moving from a model that is driven by quantity of care to one focused on patients’ health outcomes, the Centers for Medicare & Medicaid Services (CMS) will earmark $840 million to improve health outcomes and reduce unnecessary hospitalization and other overutilization of services for five million Medicare, Medicaid, and Children's Health Insurance Program beneficiaries. It is expected to transform the practices of 150,000 clinicians.

Funds will be available from 4 buckets: $670 million for practice transformation networks (PTNs); $30 million for support and alignment networks (SANs); $100 million for agency implementation; and $40 million for quality improvement organizations (QIOs) for recruitment and assessment. Group practices, health care systems, medical provider associations, and others will be eligible for the funds.

Over the next 4 years, the Transforming Clinical Practice Initiative will, through a combination of incentives, tools, and information, encourage physicians to team with their peers and others to move from volume-driven systems to value-based, patient-centered, and coordinated health care services. To qualify for the funding, successful applicants will demonstrate the ability to make progress toward measurable goals, such as improving clinical outcomes, reducing unnecessary testing, achieving cost savings and avoiding unnecessary hospitalizations.

Behind the move are the government's expectations that clinicians should:

• Share critical information with other doctors in new "medical neighborhoods," and expect to get feedback fast.
• Sort their patients by diagnosis to see on a real-time dashboard which patients need follow-up care.
• Broaden their office schedules for patients who need a short-notice visit, to avoid trips to the emergency room.
• Stop ordering unnecessary tests and performing unneeded procedures by observing the Choosing Wisely campaign's recommendations.

Organizations already participating in federal payment reform demonstrations such as ACOs, or the Comprehensive Primary Care Initiative, will be excluded “to avoid confounding effects of possible overlap,” CMS says.

Group practices, health care systems, and others that join together to serve as trusted partners through a PTN to provide practices with quality improvement expertise, best practices, coaching and assistance will be eligible for funding. These practices have successfully achieved measurable improvements in care by implementing electronic health records, coordinating among patients and their families, and performing timely monitoring and interventions of high-risk patients to prevent unnecessary hospitalization and readmissions.

CMS will award cooperative agreements to networks formed by medical professional associations and others, called SANs, who would align their memberships, communication channels, continuing medical education credits and other work to support the PTN and clinician practices.

The agency is encouraging all interested clinicians to participate in this initiative, whose deadline is January 6. For more information on the Transforming Clinical Practice Initiative, please visit: http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/