Health Care Innovation Awards (HCIA)

Objectives: The first round of the Health Innovation Awards (HCIA), announced on November 14, 2011, was a broad solicitation in which CMS welcomed a wide variety of proposals. In HCIA, Round One, CMS funded 107 Awardees who proposed compelling new models of service delivery/ payment improvements that showed substantial promise of delivering the Three-Part Aim of better health, better health care, and lower costs through improved quality for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Successful models included plans to rapidly develop and/or deploy the requisite workforce to support the proposed model. Awards recognized interventions that showed capability to improve care within the first 6 months of the award, while creating a sustainable pathway to net Medicare/Medicaid/CHIP savings within two to three years. These models of service delivery and payment improvement are now entering Year Two of the three-year period of performance for Round One of the HCIA. A second round of the Health Care Innovation Awards (HCIA) was announced on May 15, 2013. In HCIA Round Two, the Center for Medicare & Medicaid Services (CMS) will fund applicants who propose new service delivery models and design corresponding new payment models that show promise of providing better health, better health care, and lower costs through improved quality for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees. In Round Two, CMS is specifically seeking new payment and service delivery models in four broad Innovation Categories, as follows: • Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings. Priority areas are diagnostic services, outpatient radiology, high-cost physician-administered drugs, home based services, therapeutic services, and post-acute services. While preference will be given to submissions within these priority areas, CMS will consider submissions in other outpatient and/or post-acute areas within this Category. • Models that improve care for populations with specialized needs. Priority areas are high-cost pediatric populations, children in foster care, children at high risk for dental disease, adolescents in crisis, persons with Alzheimer’s disease, persons living with HIV/AIDS (in particular, efforts to link and retain patients in care and improve medication adherence that lead to viral suppression), persons requiring long-term support and services, and persons with serious behavioral health needs. While preference will be given to submissions within these areas, CMS will consider submissions that improve care for other populations with specialized needs. • Models that test approaches for specific types of providers to transform their financial and clinical models. Priority areas are models designed for physician specialties and subspecialties (for example, oncology and cardiology), and for pediatric providers who provide services to children with complex medical issues (including but not limited to care for children with multiple medical conditions, behavioral health issues, congenital disease, chronic respiratory disease, and complex social issues); and that include, as appropriate, shared decision-making mechanisms to engage beneficiaries and their families and/or caregivers in treatment choices. While preference will be given to submissions within these areas, CMS will consider submissions in other areas within this Category and from other specific types of non-physician providers. • Models that improve the health of populations – defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class – through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting. These models