CMS to Fund Networks to Help the Move to Value-Based Practice

Ken Terry

October 27, 2014

The Department of Health and Human Services (HHS) plans to invest $840 million during the next 4 years in collaborative learning and workforce training networks that are expected to support 150,000 clinicians in sharing, adapting, and further developing strategies to improve quality and lower costs.

The initiative was unveiled by HHS Secretary Sylvia Burwell on October 23 during the general session at the American Academy of Family Physicians meeting held recently in Washington, DC. The grants will be administered by the Centers for Medicare & Medicaid Services (CMS).

The overall objective, Burwell said in a news release, of the Transforming Clinical Practice Initiative is to help providers move from a care delivery system driven by volume-based reimbursement to one focused on patients' health outcomes. This program appears to be aligned with CMS' value-based purchasing program, which rewards or penalizes hospitals for meeting quality and efficiency goals and, starting next year, will do the same with physicians.

Applicants for the new government grants could include group practices, healthcare systems, and medical associations. Examples of the strategies they might emphasize in their applications are:

  • giving physicians better access to patient information, such as information on prescription drug use to help patients take their medical properly;

  • expanding the number of ways in which patients can communicate with their care teams;

  • improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and

  • using electronic health records (EHRs) on a daily basis to examine data on quality and efficiency.

Successful applicants will demonstrate the ability to achieve progress toward measurable goals, such as improving clinical outcomes, reducing unnecessary testing, achieving cost savings, and avoiding unnecessary hospitalizations, the HHS announcement said.

CMS will award cooperative agreements to healthcare organizations that join together in "practice transformation networks." These are CMS-funded learning collaboratives that will provide physician practices with quality improvement expertise, best practices, coaching, and assistance. The partners in these collaboratives will be practices that have already improved the quality of care by implementing EHRs, coordinating care with patients and their families, and monitoring and intervening with high-risk patients to prevent unnecessary hospitalizations and readmissions.

CMS will also fund "support and alignment networks" formed by professional associations and by "public-private partnerships that are currently working in practice transformation efforts," according to a CMS fact sheet. The latter organizations include those involved in such activities as developing clinical guidelines and quality measures, reducing unnecessary testing and procedures, and incorporating safety and patient and family engagement.

These networks will use "existing and emerging tools (eg, continuing medical education, maintenance of certification, core competency development)" in workforce training. The networks will place special emphasis on recruiting practices in small, rural, and medically underserved communities, the fact sheet said.

CMS estimated that "about 185,000 clinicians currently participate in existing programs, models, and initiatives that facilitate practice transformation. This represents only 16 percent of the nation's one million Medicare and Medicaid providers. Although this is an increase over previous years, there is much more work to be done."

Applications from eligible organizations will be accepted immediately. Applicants are encouraged, but not required, to submit a letter of intent by November 20, 2014. Applications are due to CMS no later than January 6, 2015. CMS anticipates it will announce the awards next spring or summer.

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