In The News

Medicare-Medicaid ACO Model joins growing number of state-based efforts to improve quality of care, lower costs

Today, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare-Medicaid Accountable Care Organization (ACO) Model, a new initiative designed to improve the quality of care and lower costs for beneficiaries who are enrolled in both Medicare and Medicaid.

The Medicare-Medicaid ACO Model builds on the current Medicare Shared Savings Program and advances efforts to partner with states in transforming the health care delivery system.

“This model aims to provide improved care coordination for those enrolled in both Medicare and Medicaid, allowing providers to focus more on providing care for their patients rather than administrative work,” said Dr. Patrick Conway, CMS acting principal deputy administrator. “CMS continues to partner with and leverage the best ideas from states to transform our health care system to improve quality and care coordination. In the long run, this partnership will result in healthier people and smarter spending.”

In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. However, Medicare ACOs often do not have financial accountability for the Medicaid expenditures for those beneficiaries. The Medicare-Medicaid ACO Model will allow Medicare Shared Savings Program ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.

CMS is accepting letters of intent from states that wish to work with CMS to design certain state-specific elements of the model. The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. CMS will enter into participation agreements with up to six states with preference given to states with low Medicare ACO saturation. Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.

The Medicare Shared Savings Program and other ACO initiatives were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. ACOs are groups of doctors, hospitals, and other health care providers who voluntarily come together to develop and execute a plan for a patient’s care and share information, putting the patient at the center of the health care delivery system.

The Affordable Care Act, through the creation of the Center for Medicare and Medicaid Innovation, allows for the testing of innovative payment and service delivery models, such as the Medicare-Medicaid ACO Model. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality.

In March 2016, the Administration announced that it met the ambitious goal – eleven months ahead of schedule – of tying an estimated 30 percent of Medicare payments to quality and value through alternative payment models by 2016. The Administration’s next goal is tying 50 percent of Medicare payments to alternative payment models by 2018. The Health Care Payment Learning and Action Network established in 2015 continues to align efforts between government, private sector payers, employers, providers, and consumers to broadly scale these efforts to achieve better care, smarter spending, and healthier people.

Today’s announcement is one in a series of Innovation Center initiatives that will expand opportunities for clinicians to participate in Advanced Alternative Payment Models under MACRA. Our work in developing and expanding new payment models will continue to be guided by the following core principles:

  • Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs.
  • Engaging with and listening to consumers, providers, and other stakeholders allowing for open and transparent dialogue, including through the appropriate use of notice-and-comment rulemaking and ombudsmen.
  • Evaluating results based on appropriately scoped and sized demonstrations and advancing best practices based on their impact on quality and cost.

We look forward to continuing to work with our many stakeholders to achieve better care for patients, better health for our communities, and lower costs through improvement for our health care system.

For more information on the Medicare-Medicaid ACO Model, including a fact sheet, please visit:

2016 Report to Congress

The U.S. Preventive Services Task Force (USPSTF or Task Force) has released its “Sixth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.”

In 2016, the USPSTF continued to fulfill its mission of improving the health of all Americans by making evidence-based recommendations about clinical preventive services such as screening tests, counseling about healthy behaviors, and preventive medications. These recommendations help clinicians and their patients make informed health care decisions.

In this annual report, the USPSTF identified six recent topics for which the current evidence was insufficient for the Task Force to make a recommendation, including autism screening and tobacco smoking cessation with electronic nicotine delivery systems. The USPSTF also identified evidence gaps that prevent it from making recommendations for specific populations or age groups, such as screening for breast cancer in African American women. Future research in these areas can help fill these gaps and would likely result in important new recommendations that will help to improve the health of Americans.

Please click here to read the complete USPSTF report.

CMS releases its Person and Family Engagement Strategy

At the Centers for Medicare & Medicaid Services (CMS), we are working with numerous partners to transform our health care delivery system to one that delivers better health outcomes while spending dollars more wisely. In November of 2015, we updated the CMS Quality Strategy, incorporating the ongoing work to shift Medicare from paying for the number of services provided to paying for better outcomes for patients. We know that a key strategy to achieving better outcomes is to meaningfully engage patients as partners in decisions about their health care. Therefore, one of the six goals outlined in this strategy is: Strengthen person and family engagement as partners in care. Today, we are excited to announce the release of the CMS Person and Family Engagement Strategy, which we believe can lead to significant progress toward this important goal.

What does person and family engagement mean? We view this as patients and families being part of the health care team by working collaboratively with their doctor or other health care professional to be active partners when making decisions about their health.

Why is this important? Because consideration of the health, values, and goals of the individual in consultation with the entire health care team leads to an improved experience and better care. When people feel responsible for their own health and are partners with their providers in goal-setting and decision-making, they are much more likely to achieve their health care goals.

  • If individuals feel their beliefs, desires, and culture are considered in their care, they are more likely to follow their care plan.
  • If individuals are able to communicate effectively with their providers and have a prominent role in making health care decisions, they will receive better care, can more effectively manage their health, and may receive appropriate preventive care while relying less on emergency or urgent care[1].

The CMS Person and Family Engagement Strategy will serve as a guide for the implementation of person and family engagement principles and strategies throughout CMS programs. This strategy will expand the awareness and practice of person and family engagement by providing the following goals and objectives:

  • Goal 1: Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being in the communities in which people live.
  • Goal 2: Promote tools and strategies that reflect person and/or family values and preferences and enable them to actively engage in directing and self-managing their care.
  • Goal 3: Create an environment where persons and their families work in partnership with their health care providers to develop their health and wellness goals informed by sound evidence and aligned with their values and preferences.
  • Goal 4: Develop meaningful measures and tools aimed at improving the experience and outcomes of care for persons, caregivers, and families. Also, identify person and family engagement best practices and techniques in the field that are ready for widespread scaling and national integration.

This Strategy emphasizes that person and family engagement goes beyond informed consent. It is about including the patients voice in policy and program planning. It is about proactive, effective communication and partnered decision-making with patients, families, and caregivers. It is about building a care relationship based on trust and inclusion of patients' beliefs, values, preferences, and culture which can even lead to a reduction in health care disparities. Health care decision-making should not always be limited to the patient and provider. It is essential to include family members, care-givers, and close friends in the conversation about health when the patient desires inclusion of others. As delivery system reform efforts move the nation to focus on the quality of care and not the quantity of care received, person and family engagement is an essential part of a health care system that delivers high quality care, spends dollars more wisely, and improves the health of people in their communities.

[1] Epstein RM, Street RL, Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225. Bethesda, MD, 2007.

'Building a System that Works: The Future of Health Care' new Health Affairs article by Secretary Burwell

The Centers for Medicare & Medicaid Services is sharing a new Health Affairs article by Secretary Burwell outlining her vision for the future of health care. In it, she touts collaboration with stakeholders like you in advancing crucial Delivery System Reform efforts — including ongoing Center for Medicare and Medicaid Innovation initiatives.

CMS Innovation Center announces two new models that will increase patient engagement care decision making

Today, the Centers for Medicare and Medicaid Services (CMS) announced two new models from the CMS Innovation Center. The Beneficiary Engagement and Incentives (BEI) Models -- the Shared Decision Making Model and the Direct Decision Support Model -- will test different approaches to shared decision making, acknowledging that beneficiaries make decisions regarding treatment options in a variety of ways.

The Shared Decision Making Model will test a specific approach to integrate a structured Four Step shared decision making process into the clinical practice of practitioners who are participating Accountable Care Organizations (ACOs). The shared decision making process is a collaboration between the beneficiary and the practitioner.

The Direct Decision Support Model will test an approach to shared decision making provided outside of the clinical delivery system by an organization that provides health management and decision support services.

Additional information on both of these models are now available on the Beneficiary Engagement and Incentives: General Information web page.

Quality Payment Program Qualified Clinical Data Registry (QCDR) and Qualified Registry Self- Nomination for the 2017 Performance Period is Open

To become a Qualified Clinical Data Registry (QCDR) or Qualified Registry for the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program, you must self-nominate. The self-nomination period for vendors who wish to participate as a QCDR or a Qualified Registry in MIPS for the 2017 performance period opened November 15, 2016 and will close on January 15, 2017 at 5:00 p.m. Eastern Time (ET).

The Centers for Medicare & Medicaid Services (CMS) provides detailed instructions regarding how to obtain a JIRA account, and how to complete and submit a Quality Payment Program Self-Nomination Form.  The Self-Nomination User Guide can be found here

Requirements to Self-Nominate

  1. Participants: You must have at least 25 participants by January 1, 2017. These participants don’t need to be using the QCDR/Qualified Registry to report MIPS data to us, but they need to be submitting data to the QCDR/Qualified Registry for quality improvement.
  2. Attestation Statement: You must provide a statement during the data submission period verifying that all data and results submitted to CMS are accurate and complete.
  3. Data Submission: You must submit data via a CMS-specified secure method for data submission, such as a QRDA or XML file.
  4. Data Validation Report: You must provide information on your process for data validation for both individual MIPS eligible clinicians and groups by submitting a data validation plan. Results of the executed data validation plan must be provided by May 31 of the year following the performance period.


For additional assistance to help support you in the self-nomination process, please see the QCDR/ Qualified Registry fact sheets that are available under the Education and Tools tab of the Quality Payment Program website,

Congress Passes 21st Century Cures Act, Bringing Forth New Era for Biomedical Innovation

December 7, 2016 

WASHINGTON, DC — FasterCures, a center of the Milken Institute, commends the U.S. Senate on today’s strong, bipartisan support of the 21st Century Cures Act (H.R. 34), which passed the Senate on a 94-5 vote, matching the U.S. House of Representatives’ vote of 392-26 on Nov. 30. The bill will now be sent to the White House. In last Saturday’s weekly address, President Barack Obama said that he would sign the bill into law as soon as it reaches his desk, enacting $4.8 billion of new funding for the National Institutes of Health (NIH) and $500 million for the Food and Drug Administration (FDA), as well as a comprehensive suite of policy provisions that will strengthen the entire biomedical innovation system.

“This landmark legislation will accelerate cures for many life-threatening diseases and help advance precision medicine,” said Michael Milken, chairman of the Milken Institute. “It assures patient-focused drug development, adds rigor to clinical trials, expands compassionate use of new drugs by dying patients, speeds the review of vaccines, addresses antibiotic resistance, responds to the opioid crisis and strengthens the nation’s research infrastructure.”

FasterCures has been honored to work with leaders in Congress, NIH and FDA throughout the bill’s journey. This is the culmination of more than two years of hard work and dedication by the bill’s bipartisan congressional champions and their staffs. House Energy and Commerce Committee Chairman Fred Upton and Representative Diana DeGette, with Ranking Member Frank Pallone, reached out to stakeholders throughout the medical research system to gather up the best ideas and translate them into legislation. Senate Health, Education, Labor and Pensions Chairman Lamar Alexander and Ranking Member Patty Murray also championed the effort and moved a set of bipartisan bills through their committee.

As the bill moved toward votes on the floors of both chambers, strong commitment from Speaker Paul Ryan, Majority Leader Kevin McCarthy and Democratic Leader Nancy Pelosi, in partnership with their Senate colleagues, Majority Leader Mitch McConnell and Democratic Leader Harry Reid, resulted in the overwhelmingly bipartisan votes we’ve seen in the past few days. Improving the biomedical innovation system is truly something that all can agree on.

“The time for medical research progress is now. We are so pleased that Congress seized this opportunity and united around this strong legislation,” said Margaret Anderson, executive director of FasterCures. “This act will invest in and strengthen the federal research system, which will support the United States’ long-standing tradition of scientific progress and hopefully spur advances for the many patients who are desperately waiting for effective treatments and cures.”

The 21st Century Cures legislation addresses the entire biomedical innovation system, and would support many of the recommendations from FasterCures’ Rx for Innovation project. Here are just a few examples from this comprehensive legislation:

  • Enhances patient centricity in biomedical product development and regulatory approval.
  • Bans efforts to block data sharing between health information systems, and provides the Department of Health and Human Services the authority to levy civil penalties against offenders.
  • Reforms FDA hiring authorities to fill the agency’s vacancies by enabling it to compete more effectively with industry to hire and retain the best and brightest experts to review medical product applications.
  • Expands the translational work done by the NIH’s National Center for Advancing Translational Sciences.
  • Catalyzes innovation in clinical trials and regulatory approval, without diminishing FDA’s authority to determine what constitutes a safe and effective medical product.

The new funding for NIH will provide $1.5 billion for the Precision Medicine Initiative, $1.8 billion for the Beau Biden Cancer Moonshot and $1.5 billion for the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative. All of these initiatives have the potential to significantly advance our understanding of disease and identify opportunities for new therapies.

FasterCures looks forward to working with Congress, the Obama administration and the incoming Trump administration to help implement the 21st Century Cures Act, realizing its promise to support scientific breakthroughs, translate those discoveries into medical products and deliver those treatments and cures to the patients who need them. There are approximately 10,000 diseases and 500 treatments; even with today’s vote, we still have work to do.

New From AHRQ - Be Prepared to be Engaged: A Patient-Based Intervention Strategy for Primary Care

Patients and their families who arrive well-prepared to primary care visits are more likely to have important questions and concerns addressed by their health care team. Evidence suggests that engaging patients and families in discussions about their care leads to significant improvements in patient safety, care quality and patient experience. AHRQ’s new Be Prepared to be Engaged strategy, part of the agency’s Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families, features strategies for patients to prepare for primary care visits and improve the likelihood of leaving their visit with an understanding of their diagnosis and care plan, all of which can improve patient safety.

AHRQ Funding Opportunity:  Developing Measures of Shared Decision Making (R01)

A new funding opportunity announcement from AHRQ solicits applications for research projects to develop, test and evaluate measures of shared decision making for research conducted in clinical settings. Shared decision making is a collaborative process in which patients and members of their clinical team make health care decisions that are informed by scientific evidence as well as patients’ values and preferences. Each project is expected to produce valid and reliable measures of shared decision making, along with instructions for implementing the measures, as well as documentation on the development, testing and evaluation of the measures. Maximum costs for each project are $500,000 per year and $1.5 million for entire project periods up to three years.