Value Based Purchasing and Health Care Reform

CMS Announces Pioneer ACO Model Participating Organizations

For additional information, see the following links:

HHS News Release - Affordable Care Act helps 32 health systems improve care for patients, saving up to $1.1 billion (12/19/2011)

CMS Pioneer ACO Organizational Model - Fact Sheet (12/19/2011)

HHS Releases Physician Payments Sunshine Act Proposed Rule

Section 6002 of the Affordable Care Act (also referred to as the “Physician Payments Sunshine Act”) requires public disclosure of the financial relationships between physicians and the pharmaceutical, medical device and biologics industries.  The Affordable Care Act also requires the Department of Health and Human Services (HHS) to establish reporting procedures for applicable manufacturers to submit such information on an annual basis, as well as procedures for making that information available to the public.  Under the law, applicable manufacturers and applicable group purchasing organizations (GPOs) must submit report certain information regarding the ownership or investment interests held by physicians or the immediate family members of physicians in such entities to HHS.

Comments regarding the Proposed Rule will be accepted until 5:00 p.m. (EST) on February 17, 2012.

Additionally, the Senate Special Committee on Aging had scheduled a hearing entitled, “Parting the Clouds: Implementing the Physician Payments Sunshine Act” for this afternoon (December 15, 2011) to discuss the implementation of the law.  However, following the release of the Proposed Rule, the Chairman of the Committee released a statement announcing the Committee’s plan to review the Proposed Rule and reschedule the hearing for early next year.    

To see the text of the Proposed Rule, see the following link:

Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests – Proposed Rule (to be published in Federal Register on 12/19/2011)

HHS Releases CO-OP Program Final Rule

This final rule implements the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster creation of consumer-governed, private, non-profit health insurance issuers to offer qualified health plans through the new, competitive health care marketplaces in each State, called the Affordable Insurance Exchanges. 

For additional information, see the following:

New Federal Loan Program Helps Nonprofits Create Customer-Driven Health Insurers (CMS - The Center for Consumer Information & Insurance Oversight)

Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program - Final Rule (12/8/2011) (to be published 12/13/2011)

Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program - Final Rule (Federal Register 12/13/11)

CMS to Host Third Health Care Innovation Challenge Webinar on Dec. 13th

As described below, the Department of Health and Human Services recently announced the Health Care Innovation Challenge from the CMS Innovation Center, a new initiative designed to test creative ways to deliver high quality medical care and reduce costs across the country.  In this third of four-webinar series on the Innovation Challenge, CMS Innovation Center staff will be presenting an explanation of “Total Cost of Care” and how potential applicants can demonstrate their path to achieving lower costs through improvement.

WHAT:  Health Care Innovation Challenge Webinar 3: “Achieving Lower Costs Through Improvement”

WHEN:  Tuesday, December 13, 2011 @ 2-3pm EST

WEBCAST:  http://www.visualwebcaster.com/CMS/83924/reg.html

If participants are unable to hear the audio for the webinar via their computer speakers, and/or would prefer to listen via their telephone, please dial 877-261-8937 and enter code 31613148#.

A fourth webinar has been scheduled for 2-3pm EST on Monday, December 19^th, 2011 to discuss how potential innovative proposals can demonstrate measurable impact on the aims of better care and better health in addition to considerations for operational planning for potential applications.

HHS Releases MLR Final Rule

For additional information, see the following links:

Medical Loss Ratio Requirements under the Patient Protection and Affordable Care Act

MLR Final Rule Fact Sheet

Medical Loss Ratio Rebate Requirements for Non-Governmental Plans

 

Health Care Innovation Challenge Webinar Available on Innovation Center's Website

The Center for Medicare and Medicaid Innovation has posted the Slides, Transcript and a link to the Audio Recording from the November 17th Health Care Innovation Challenge webinar on its Health Care Innovation Challenge website.  On December 6th, the Innovation Center hosted the second Health Care Innovation Challenge webinar, which focused on the program's application process and project proposal design.  The Innovation Center plans to make information from the December 6th webinar on its website soon.

On December 13th, the Innovation Center will host another Health Care Innovation Challenge webinar.  The December 13th webinar will focus on quality measurement and financial plans.

For additional information regarding the Health Care Innovation Challenge, see the following links:

Funding Opportunity Announcement (FOA)

Health Care Innovation Challenge Fact Sheet