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The Centers for Medicare and Medicaid Services is making about $1 billion in grants available in a second round of funding under the Affordable Care Act to support innovative ways to improve health care outcomes.
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CMS in 2012 awarded 107 Health Care Innovation Awards for a variety of initiatives across the nation. The goals of that grant program were to avoid mistakes and readmissions, improve population health status, reward quality rather than quantity, and create supporting health information technology infrastructures.
This year, the agency is focusing its new three-year grant awards on four core areas: rapidly reducing costs in outpatient and post-acute settings, improving care for patient populations with specialized needs, testing improved financial and clinical models for certain types of providers, and linking clinical care delivery to preventive and population health.
“In this round, CMS specifically seeks new payment models to support the service delivery models funded by this initiative,” according to the funding opportunity announcement. “All applicants must submit, as part of their application, the design of a payment model that is consistent with the new service delivery model that they propose.”
CMS will accept letters of intent between June 1 and June 28, and applications between June 14 and August 15.
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The American Medical Association has created a Health Insurer Code of Conduct Principles and challenges payers to commit to following the code.
Several of the 10 principles relate to the use of information technology. Provisions under the third principle, Access to Medical Care, call for provider directories to be easily available in paper and electronic formats. Both formats should provide specific information, including clear disclosures if a provider is in a restricted 'tier' of coverage or 'out of network,' along with terms of financial and access limitations.
Under the Administrative Simplification principle, the AMA calls for insurers to comply with all laws governing use of electronic transactions, and the dissemination of clear, timely and accurate eligibility and benefit information on request, among other provisions.
The Claims Processing Principle demands timely and accurate payment with clear and comprehensive explanations of how each claim was handled and specific reasons for denial or reduction of payment.
The complete code, which 68 state and specialty medical societies have endorsed, is available at ama-assn.org/go/codeofconduct.
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