The Innovation Center’s Activities, Funding, Organization, and Staffing Focused on Implementing 17 New Models

From the time it became operational in November 2010, through   March 31, 2012, the Innovation Center’s activities and use of funding  focused on implementing 17 new models to test different approaches to  health care delivery and payment in Medicare and Medicaid. The Innovation Center projects that the total funding required to test and  evaluate these 17 models will be $3.7 billion over their lifetime, including  $2.7 billion for the 11 models selected by the Innovation Center and   $1.0 billion for the 6 models specifically required by other provisions of  PPACA. The expected funding for individual models ranges from   $30 million to $931 million, depending on model scope and design. As of August 1, 2012, the Innovation Center was still relatively early in the  process of implementing the 17 models. The Innovation Center’s Organization and Staffing Reflect Its Focus on the 17 Models and Other Key Functions That Support Model Implementation

As of March 31, 2012, the Innovation Center’s 184 staff were organized  into nine groups and the Office of the Director. For example, because most of the  models that the Innovation Center selected for implementation were  Patient Care and Seamless Care Models, more staff were hired in those   Similarly, the Rapid  groups than in the Preventive Care Models Group.Cycle Evaluation Group and the Business Services Group were among  the largest groups by staff size because of (1) the Innovation Center’s  need for evaluation expertise when selecting which models to test as well  as its responsibility for evaluating existing demonstrations and (2) the  need for staff to carry out key administrative activities right away,  including contract solicitation, budget development, and hiring. The Innovation Center’s Plans for Evaluating Models Include Identifying Measures Related to the Cost and Quality of Care and Hiring Contractors

As part of its evaluation of individual models, the Innovation Center plans  to identify measures related to the cost and quality of care. Preliminary measures the Innovation Center identifies will be finalized  with contractors responsible for evaluating models on behalf of CMS. As of August 1,  2012, the Innovation Center had contracted with evaluators for 10 of the  17 models and had finalized measures for 2 models.anticipated awarding contracts for 6 of the remaining models by the end  of fiscal year 2012 and for the other remaining model—the Strong Start  for Mothers and Newborns model—by March 2013. The Innovation Center’s Plans for Evaluating Its Own Performance Include Aggregating Data across Models and Monitoring Implementation of Models

The Innovation Center’s plans for evaluating its own performance include  aggregating data on cost and quality measures to determine the overall  impact of the center. While the center uses a number of mechanisms to  coordinate with other CMS offices, it is still working on ways to make  coordination more systematic. Some Innovation Center Models Overlap with Efforts of Other CMS Offices

We identified three key examples of Innovation Center models being  implemented as of March 31, 2012, that overlap with efforts of other CMS  offices, meaning that the efforts share similar goals, engage in similar  activities or strategies to achieve these goals, or target similar  populations. However, these overlapping efforts also have differences,  and CMS officials said they are intended to be complementary to each  other. The Innovation Center Uses a Number of Mechanisms to Coordinate with Other Offices, but Is Still Working on Ways to Make Coordination More Systematic

Over the period of our review, we identified a number of mechanisms the  Innovation Center uses to coordinate its work in order to avoid  unnecessary duplication in models that overlap with efforts of other CMS  offices. In using these mechanisms, the center has engaged in key  practices that we identified in prior work as helping enhance and sustain  collaboration, such as leveraging resources, establishing compatible  policies and procedures, and developing ways to report on results across  offices. Multi-office meetings at the staff, director, and agency level. The Innovation Center is also currently developing a process to ensure  that CMS does not pay for the same service under both HEN and QIO  contracts. CMS officials  said that they will take steps, including potentially modifying HEN or QIO  contract language, to eliminate any unnecessary duplication of effort that  the review identifies and to document how this duplication was  addressed. Recommendations for Executive Action

In order to ensure the efficient use of federal resources, we recommend  that the Administrator of CMS direct the Innovation Center to  expeditiously complete implementation of its process to review and  eliminate any areas of unnecessary duplication in the services being  provided by HENs and QIOs in hospitals. In its written comments, HHS stated that it concurred with our  recommendation to expeditiously complete implementation of its process  to review and eliminate any areas of unnecessary duplication in the  services being provided by HENs and QIOs. Develop an Innovation Center Investment  Proposal (ICIP)
As part of this selection process, the Innovation Center reviews model types  suggested in the Patient Protection and Affordable Care Act (PPACA) provision  that established the center, and seeks input from across the Centers for Medicare  & Medicaid Services (CMS), the Department of Health and Human Services  (HHS), and other federal partners and from an array of external stakeholders.
Why GAO Did This Study

PPACA created the Innovation Center within CMS. The purpose of the Innovation Center is to test new approaches to health care delivery and payment--known as models--for use in Medicare or Medicaid. GAO was asked to review the implementation of the Innovation Center. Specifically, GAO: (1) describes the center's activities, funding, organization, and staffing as of March 31, 2012; (2) describes the center's plans for evaluating its models and its own performance; and (3) examines whether efforts of the center overlap with those of other CMS offices and how the center coordinates with other offices. GAO analyzed budget and staffing data; reviewed available documentation, such as Innovation Center policies and procedures and functional statements for CMS offices; and interviewed officials from the Innovation Center and other CMS offices, such as the Center for Medicare. GAO assessed how the Innovation Center coordinates in the context of federal internal control standards and key practices for collaboration from prior GAO work.

What GAO Found

From the time it became operational in November 2010, through March 31, 2012, the Center for Medicare and Medicaid Innovation (Innovation Center) has focused on implementing 17 new models to test different approaches for delivering or paying for health care in Medicare and Medicaid. The center is still relatively early in the process of implementing these models. Eleven of the models were selected by the Innovation Center under the provision in the Patient Protection and Affordable Care Act (PPACA) that established the center, while the remaining 6 were specifically required by other PPACA provisions. The Innovation Center projects that a total of $3.7 billion will be required to fund testing and evaluation of the 17 models, with the expected funding for individual models ranging from $30 million to $931 million. As of March 2012, the center's 184 staff were organized into four groups responsible for coordinating the implementation of different models and another five groups responsible for key functions that support model implementation. Officials said that, among other things, the center's initial hiring of staff reflected the need for leadership and for specific types of expertise, such as individuals with a background in evaluation.
The Innovation Center's plans for evaluating individual models include identifying measures related to the cost and quality of care. Officials from the Centers for Medicare & Medicaid Services (CMS) told GAO that the Innovation Center had developed preliminary evaluation plans for the 17 models being implemented that, among other things, identified proposed measures. According to CMS officials, these measures will be finalized by contractors responsible for evaluating, on behalf of CMS, each model's impact on cost and quality. As of August 1, 2012, the Innovation Center had contracted for the evaluation of 10 of the 17 models. The center's plans for evaluating its own performance include aggregating data across models by using a set of core measures it has developed. In addition, the Innovation Center has taken steps to monitor its progress in implementing the 17 models through biweekly reviews of standard milestones and related data, such as the number of applications to participate in a model the center has received.
GAO identified three key examples of overlap between the 17 Innovation Center models and the efforts of other CMS offices, meaning that the efforts share similar goals, engage in similar activities or strategies to achieve these goals, or target similar populations. However, these overlapping efforts also have differences, and CMS officials said the efforts are intended to be complementary to each other. GAO also identified a number of mechanisms the Innovation Center uses to coordinate its work in order to avoid unnecessary duplication between its models and other efforts, such as multi-office meetings at the staff, director, and agency level. Further, through using these mechanisms, the Innovation Center has engaged in key practices for collaboration, including leveraging resources across offices. At the same time, the center is still working on ways to make its coordination more systematic. For example, largely because of questions raised during GAO's review, the Innovation Center initiated a process to ensure that CMS does not pay for the same service under the contracts in one of its models and those in another CMS office. However, officials told GAO that the center is still working on implementing this process and may need to take additional steps to eliminate any unnecessary duplication. GAO is recommending that the Administrator of CMS direct the Innovation Center to expeditiously complete its process to review and eliminate any areas of unnecessary duplication in contracts that have been awarded in one of its models. HHS agreed with this recommendation and described steps it is taking to address unnecessary duplication.

What GAO Recommends

GAO is recommending that the Administrator of CMS direct the Innovation Center to expeditiously complete its process to review and eliminate any areas of unnecessary duplication in contracts that have been awarded in one of its models. HHS agreed with this recommendation and described steps it is taking to address unnecessary duplication.