This summer the Centers for Medicare & Medicaid Innovation announced 81 Health Care Innovation Awards made pursuant to the Affordable Care Act. Recipients were selected based upon their innovative solutions to addressing problems facing their communities and their ability to “deliver high-quality medical care, enhance the health care workforce, and save money.” See The U.S. Department of Health & Human Services Page. The awards will be made over a three year period pursuant to cooperative agreements.
Each of the selected projects demonstrates the federal government’s interest in enhancing quality of care and improving efficiency within the health care system through evidence based medicine, information technology and patient-centered coordinated care.
Recipeints of the Health Care Innovation Awards are located in all 50 states, the District of Columbia and Puerto Rico, including without limitation 8 projects in Michigan and 13 projects in New York.
Two recipients that exemplify the types of initiatives currently embraced by CMS (and, more specifically, the Health Care Innovation Awards) are described below.
Reducing Inappropriate Imaging in Southeast Michigan
The Altarum Institute, in partnership with United Physicians and Detroit Medical Center Physician Hospital Organization, has received an $8.4 million dollar award from CMS to reduce unnecessary medical imaging. Through this program (titled “Comprehensive community-based approach to reducing in appropriate imaging”), Altarum will “embed clinical guidelines in the image ordering process, leverage health information exchange capabilities to increase awareness of past imaging results and use patient education campaigns to offset patient-induced demand for medically unnecessary imaging.” The goal is a 17 percent reduction in imaging costs (and also a reduction in associated medical risks of performing unnecessary imaging) without reducing the quality of care provided to patients. Altarum also intends to implement this project in conjunction with the American College of Radiology.
Coordinating Care of the Mentally Ill in Southwest Brooklyn
Maimonides Medical Center, in partnership with numerous other health care and community organizations, insurers and a labor union, has received a $14.8 million dollar award from CMS to improve care for adults with serious mental illness who live in southwest Brooklyn. The project would enable medical and mental health providers to communicate with each other through use of advanced health information technology. The goal is to reduce psychiatric and medical hospital admissions by 30%.
As providers and suppliers within the medical community contemplate participation in projects such as those described above, through acquisition or use of information technology or otherwise, it is highly advisable to engage legal counsel to provide compliance guidance and review participation and other agreements before proceeding. Competent and experienced attorneys are able to identify potential regulatory issues and ensure that their clients maintain flexibility (to the greatest extent practicable) in this rapidly changing health care environment.
For more information regarding this and related issues, please contact Claudia Hinrichsen, Esq. or Carey Kalmowitz, Esq. or visit the HLP website.