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February 16, 2015

CMS: Crowd-sourcing clinical improvements

The times, they are a changing, and there’s nowhere that’s more true than in healthcare. In the last year, the department of Health and Human Services (HHS), under the auspices of the Centers for Medicare and Medicaid Services (CMS) has begun instituting systemic changes — including the Readmissions Reduction Program, to reward organizations that minimize patient readmissions; value-based purchasing, which ties reimbursement to quality of care outcomes; and the Physician Sunshine Act, which reports payments, transfers, ownership and gifts given to physicians and teaching hospitals — meant to change the way healthcare organizations practice.

Now, HHS and CMS have announced the Transforming Clinical Practice Initiative: special funding for applicants (group practices, healthcare systems, medical provider associations, etc.) that work directly with medical providers to rethink and redesign their practices, moving from quantity-driven systems to ones focused on outcomes for patients and coordination of healthcare delivery. This program seeks in particular to help “clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs,” and fits snugly into HHS’s amplified focus on better care and more cost-effective use of resources.

There’s an $840 million pot up for grabs over the next 4 years for applicants to share, adapt and further develop comprehensive quality-improvement strategies. CMS estimates that only 16% of the nation’s 1 million Medicare and Medicaid providers participate in initiatives that facilitate practice transformation. Essentially, HHS and CMS have laid the groundwork, and now they’re looking to crowd-source the revolution.

Suggested strategies could include:

  • Giving doctors better access to patient information (e.g. information on prescription drug use to help patients take their medications properly).
  • Expanding the number of ways patients are able communicate with the team of clinicians taking care of them.
  • Improving the coordination of patient care by primary care providers, specialists, and the broader medical community (e.g. using real-time documentation from scribes to ensure other departments or facilities are fully informed about patients).
  • Using electronic health records on a daily basis to examine data on quality and efficiency.

CMS will award cooperative agreement funding for two network systems under this initiative: Practice Transformation Networks, as well as Support and Alignment Networks. Practice Transformation Networks are peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice transformation. This approach lets clinician practices become actively engaged in the transformation and ensures collaboration among a broad community of practices that creates, promotes, and sustains learning and improvement across a healthcare system. Support and Alignment Networks will provide a system for workforce development utilizing national and regional professional associations and public-private partnerships that are currently working to improve outcomes and cost-effectiveness. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development) these networks will help ensure sustainability of these efforts, particularly supporting the recruitment of clinician practices serving small, rural and medically underserved communities and play an active role in the alignment of new learning.

Frontline providers and healthcare managers are busy (bordering on overburdened), it’s true. But they’re also seeing how the system works, day in and day out. Surely, you have ideas about how things could be better run within your organization, or between yours and another. HHS and CMS want to harness that energy, and fund those who want to make a real difference. CMS expects to announce awards by summer.

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