CMS Financial Alignment Initiative
Problem
There was inefficient coordination of care for people enrolled in both Medicare and Medicaid.
Individuals who are dually eligible for Medicare and Medicaid are among the nation’s most vulnerable populations. They also account for a disproportionate share of the nation’s health care spending. Without coordination between the two systems, inefficiencies and cost duplication ensue. To explore options for improving clinical care while reducing costs, the Centers for Medicare & Medicaid Services (CMS) created the Financial Alignment Initiative (FAI) to test different approaches to coordinating care and financing across Medicare and Medicaid.
Solution
NORC supported CMS’s Financial Alignment Initiative.
CMS contracted NORC to serve as FAI’s Operation Support Contractor. Initially, this involved conducting readiness reviews to ensure that health plans and states could implement the program’s requirements. As the program became operational, we developed monitoring performance measures that each participating health plan was required to report. Our current focus is ensuring that health plans and states submit performance measure information at required intervals, collecting and analyzing this information, and providing monthly, quarterly, and annual reports to CMS. Additionally, we work with CMS to develop a public use file that contains information on how each health plan has scored on a variety of measures. We also run help desks for each participating state that provide technical assistance on measures and reporting, and we offer webinars and FAQ documents that clarify requirements for each measure. Finally, we conduct analyses that support the quality withhold threshold that determines what proportion of withheld payment each health plan is eligible to receive as a result of their performance.
Result
NORC provided support and monitoring to 69 health plans across ten states.
After a successful initial five-year contract, CMS awarded NORC a second one and now a third contract to continue monitoring health plan performance. This ongoing collaboration with CMS is a testament to our ability to manage complex and evolving operations, anticipate requirements, develop procedures and performance metrics, and provide operational support that has allowed CMS to collect the data required to evaluate different models and ultimately improve lives.
Related Tags
Project Leads
-
Michelle Strollo
Senior Vice PresidentSenior Advisor -
Lisa Rosenberger
Principal Research DirectorProject Director -
Rina Dhopeshwarkar
Principal Research ScientistSenior Advisor -
Kathleen Taylor
Senior Research DirectorProject Manager -
Yuqing Zhang
Research ScientistTask Lead
“We have been instrumental in keeping these programs going, and demonstrations rolling, allowing CMS and the states to monitor what’s going on through the duration.”
