The Center for Medicare & Medicaid Innovation is a federal agency within the U.S. Department of Health and Human Services (HHS) tasked with exploring, testing, and implementing innovative healthcare payment and service delivery models to improve the quality of care for Medicare and Medicaid beneficiaries while reducing costs.
Healthcare innovation refers to the development and implementation of new ideas, technologies, processes, and models aimed at improving health outcomes, enhancing patient experiences, and reducing healthcare costs. CMMI plays a central role in fostering and supporting innovation in the healthcare sector.
Value-based care is a healthcare delivery model that emphasizes improving patient outcomes while controlling costs. It focuses on paying for quality and outcomes rather than the volume of services provided. CMMI often develops and tests value-based payment models to incentivize healthcare providers to deliver high-quality, cost-effective care.
Payment models refer to the methods used to reimburse healthcare providers for the services they deliver. CMMI develops and tests various payment models, including accountable care organizations (ACOs), bundled payments, and alternative payment models (APMs), to align financial incentives with the goals of improved quality and efficiency in healthcare delivery.
Alternative payment models are payment approaches that incentivize healthcare providers to deliver high-quality, cost-effective care by linking reimbursement to performance on quality and cost measures. CMMI designs and tests APMs to encourage providers to adopt value-based care practices and move away from fee-for-service payment models.
Quality measures are standardized metrics used to assess the performance of healthcare providers and organizations in delivering high-quality care. CMMI incorporates quality measures into its payment models to evaluate and incentivize providers based on their performance in areas such as patient outcomes, patient experience, and adherence to clinical guidelines.
Patient-centered care is an approach to healthcare delivery that prioritizes the needs, preferences, and values of individual patients. CMMI promotes patient-centered care by designing payment models and interventions that aim to improve care coordination, enhance patient engagement, and empower patients to actively participate in their own healthcare decisions.
Population health management involves the systematic efforts to improve the health outcomes of a defined group of individuals, typically within a specific geographic area or healthcare organization. CMMI supports population health management initiatives by testing innovative care delivery models and interventions aimed at addressing the health needs of diverse patient populations.
Healthcare transformation refers to the fundamental changes in the organization, delivery, and financing of healthcare services aimed at achieving better outcomes, lower costs, and improved patient experiences. CMMI plays a key role in driving healthcare transformation by piloting and scaling innovative approaches to care delivery and payment reform.
Stakeholder engagement involves involving various stakeholders, including patients, healthcare providers, payers, policymakers, and community organizations, in the design, implementation, and evaluation of healthcare initiatives. CMMI actively engages stakeholders to gather input, build consensus, and ensure the success and sustainability of its innovative healthcare models and programs.