The Centers for Medicare and Medicaid Services (CMS) announced two large-scale demonstration projects on January 27 designed to test the potential of exemplary practices in care coordination, pay-for-performance, and health information technology to drive improvements in quality and efficiency of care. Over 130,000 Medicare/Medicaid beneficiaries in North Carolina and Indiana will be served under the two projects. The projects are designed to encourage patient-centered, shared decision-making, and will allow providers to share in savings with CMS if CMS quality and cost containment goals are achieved.
The North Carolina Community Care Network (NC-CCN) demonstration project will expand an existing "medical home" model to new groups of patients including persons with Medicare/Medicaid dual eligibility. It builds on a successful project (long familiar to PCG) that has served persons solely eligible for Medicaid as well as certain other low-income and uninsured groups. The existing NC-CCN networks include community care physicians, hospitals, county health departments, and other providers coordinating patient care in their capacity as "medical homes". Eight of the 14 NC-CCN networks and 26 counties will participate in the new demonstration project, which will assess the Medicare impact of NC-CCN's exemplary care coordination practices that may be supported by advanced health IT tools including electronic health records (EHR), e-prescribing, clinical decision support systems, secure messaging, and Web portal software.
The Indiana Health Information Exchange (IHIE) demonstration will assess the impact of a multi-payer, quality reporting/improvement, and pay-for-performance initiative involving Medicare, Medicaid, employer-sponsored health plans, and other private insurance payers. It will be the first large scale CMS sponsored demonstration project of its kind. It is designed to address concerns that payers' data silos and payment incentives for quality and efficiency can fall short if not effectively integrated and aligned. The project builds on the exceptional strengths of the existing HIE network in the Indianapolis MSA region. Over 800 providers in the region will participate in this extraordinary demonstration project.
