How do we ensure that innovative payment models protect Medicare beneficiaries?

Challenge

Compared to similar countries, the U.S. spends much more on health care and produces worse health outcomes.

To address this growing problem, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI), which tests innovative models of health care payment and delivery. CMMI works with health care providers across the care continuum to reduce costs and improve quality of care.

To conduct valid and ethical tests of payment models, providers in the models must adhere to the models’ rules and CMMI must protect Medicare beneficiaries’ safety and access to care as well as the integrity of the Medicare program.

Westat supports CMMI in its efforts to monitor multiple innovative payment models.

Solution

Westat conducts monitoring and compliance activities to protect Medicare beneficiaries and ensure the validity of innovative payment model tests.

• Westat provides technical assistance and education and outreach services to ensure that providers involved in innovative payment models understand and adhere to program rules.
• We analyze Medicare claims and other data sources to monitor how innovative payment models’ incentives impact Medicare beneficiaries’ outcomes and patient safety.
• We conduct rigorous reviews of providers’ processes and documentation to protect the models’ integrity.   

Results

CMMI’s innovations in health care delivery and finance, designed to improve care for vulnerable populations, can be tested robustly and safely because providers adhere to the program rules and beneficiaries’ outcomes are monitored to guard against harm and reductions in freedom of choice and access to care.