CMS announced new demonstration programs it plans to implement to “identify, develop, test, and disseminate major and multi-faceted improvements to the health care system.” The Medicare Modernization Act requires that Medicare conduct a five-year demonstration program to achieve four main goals: (1) to improve patient safety; (2) to enhance quality; (3) to increase efficiency; and (4) to reduce the variations in medical practice that yield poorer quality and increased costs. The two demonstration programs to be initiated are in Indiana and in North Carolina.
The Indiana demonstration program–Indiana Health Information Exchange (IHIE)–will consist of a regional, multi-payer, pay-for-performance program that is based upon a common set of healthcare quality measures. CMS hopes that this program will provide key empirical evidence demonstrating how effective the pay-per-performance, health IT, and multi-payer initiatives are to improving quality and efficiency.
The North Carolina demonstration program–North Carolina Community Care Networks (NC-CCN)–is aimed at evaluating the organization, delivery, and financing of healthcare that are all used to increase the quality and efficiency of the healthcare system. NC-CCN is a non-profit organization that will provide a model that “combines a physician- directed care management approach with a variety of information technology applications designed to support care coordination and evidence-based practice, and a regional physician pay-for-performance program using a common set of quality measures.” Currently NC-CCN only serves Medicaid beneficiaries, but the demonstration program will expand to dual eligible and Medicare-only beneficiaries, as well.