Jain: There's a place for innovation at CMS

WORCESTER, Mass.—Section 3021 of the Patient Protection & Affordable Care Act (PPACA) "is going to change the world," proclaimed Sachin Jain, MD, senior advisor to the administrator of the Centers for Medicare & Medicaid Services (CMS) during the 2011 Massachusetts Governor’s Health IT Conference May 9 and 10. “Are there any nerds out there who know Section 3021?”

Section 3021 establishes the Center for Medicare and Medicaid Innovation, Jain said. That section of the PPACA sets aside $10 billion every 10 years for Medicare and Medicaid to innovate, to find new models of payment and care delivery, and diffuse them to the Medicare and Medicaid programs, Jain remarked.

Innovation is needed, he said, although healthcare innovation doesn't take place in Washington, D.C. but on the front lines. However, a tension exists: “The better job that we do clinically results in failures financially. That’s the crux of healthcare innovation. It’s the reason we needed federal stimulus to actually promote health IT because there wasn't a financial incentive before that."

The establishment of the Center for Medicare and Medicaid Innovation is unique because of new authorities granted to the Secretary of the Department of Health and Human Services, according to Jain. “The new authorities are so profound in their reach that the secretary has the ability to take any single demonstration that reduces costs and improves quality and diffuse that program to the whole of the Medicare and Medicaid programs without any act of Congress,” he said.

“All of the sudden, Medicare and Medicaid have a capacity for innovators. People who have good ideas for how to improve quality and reduce costs now have a way to interface with the CMS to change payment policies to sustainably reward the improvements. This is a game-changer, ladies and gentlemen. This will fundamentally alter the landscape of healthcare in this country,” Jain said.

So how do innovators interface with the center? “This innovation center is your innovation center. We need your ideas. Our process for how we’re going to begin to launch projects and initiatives is geared toward first getting your input and developing programs around the ideas you present in a competitive application process,” Jain remarked.

There are seven "doors" to the innovation center, he said:

• Request for proposals: CMS will put out proposals in priority areas of interest.
• Medicare modernization: “There are some policies built into Medicare that anyone who's ever taken care of a patient [on] Medicare know aren’t good for patients," he claimed. "We want to take ideas from the field about how Medicare payment policies are doing harm to patients and fast-track those ideas into innovation center pilots [to reduce/eliminate that harm].”
• Request for information: CMS wants to know what priority areas tp focus on as well as suggested solutions to those priority problems—CMS wants to use this information to help guide the formation of the request for proposals.
• Sole-source contracting: Most work will be done through competitive bidding, Jain noted, but some ideas will be unique enough to entertain the notion of sole-source contracting.
• Prizes and challenges: To get the nation to work on health challenges, CMS will reward innovations in those areas.
• "The evidence-based door": CMS will fast-track ideas that already have good evidence into policy. We’re still working with our lawyers to better understand what our real authorities are in that regard,” Jain noted.
• Innovation and test networks: “We want some organizations that we work with in rapid succession to be able to test new models and ideas as they come up.”

“There is some light in this,” Jain concluded. “The light is coming from the Center for Medicare and Medicaid Innovation.”