ACA - Testing a Model of Data Aggregation under the Comprehensive Primary Care initiative

 

The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health insurance companies (“payers”) to strengthen primary care. Recognizing that the impact of any one payer alone is limited, the payers in CPC have committed to establishing an approach that is coordinated with that of the Innovation Center to transform the way in which primary care is practiced and financially supported.

In May-July 2012, the Innovation Center executed a Memorandum of Understanding (MOU) with each participating payer. One of the stated goals in the MOU is improving the flow of cost and utilization data to CPC primary care practices to support practices in their efforts to improve outcomes through care coordination and quality improvement. The MOU described a collaboration by which each regional group of payers – with CMS’ input – would produce a written plan “that outlines how participating payers will transition to a common approach for sharing data with participating primary care practices.”

The MOU defined this endeavor in the following way:
. . . If an appropriately structured and protected multi-payer claims data system exists or can be created in [Market] to support a common approach for sharing data with participating primary care practices, the Innovation Center and [payer] will submit its data to the system.

In order to improve care coordination and support practices to provide better patient care, payers have agreed to work together to improve data-sharing to practices. The goal of data aggregation is to combine patient-level cost and utilization data from all payers in a uniform and actionable format so that physicians can better coordinate care across their entire population. This data will help CPC primary care practices deliver better care to their patients by providing information to support their efforts to improve care outcomes through care coordination and quality improvement. CPC practices have been asking for this data to be aggregated for their practice rather than to receive it individually from each payer, which has been cumbersome and less useful for them in managing the health of their patients. Payers in four CPC regions have been delivering data in this format, but Medicare data has not to date been included.

The purpose of this program is to support vendors in four CPC regions to combine Medicare claims data with claims data from other commercial payers in each respective region and create actionable feedback reports for practices to improve care coordination and population health, and decrease costs. The end-users of this aggregated data are the CPC practices; including Medicare data in this demonstration is central to the stated goal of improving care coordination by providing actionable data to primary care practices. We are proposing to add Medicare data in CPC regions with existing multi-payer databases to test a model of data aggregation within the CPC initiative to better understand how Medicare data may be incorporated and used by practices to improve care coordination and quality improvement. The activities funded by these cooperative agreements are projected to run for the duration of the CPC initiative, currently scheduled to end December 31, 2016.

Specifically, these cooperative agreements are intended for vendors in four CPC regions:
•Taconic Health Information Network Community (THINC) in the Capital-District Hudson Valley region of New York;
•The Health Collaborative in the Cincinnati-Dayton region of southwestern Ohio and northern Kentucky;
•MyHealth in the greater Tulsa region of Oklahoma; and
•Rise Health in Colorado

The CPC payers in each region have selected the vendors listed above as their data aggregation vendors and have asked CMS to provide Medicare data to these vendors to be included in these existing multi-payer databases. Each group of regional payers is structuring their data aggregation system independently (i.e. these efforts are not connected across regions). Each group of regional payers has already entered into contractual relationships with their respective vendors. The data aggregation vendors, the intended awardees for these cooperative agreements, are establishing multi-payer claims databases specific to the payer data for the CPC practices in their geopgraphic region. CMS participation in the data aggregation initiative will pay for Medicare data to be incorporated into the multi-payer databases serving CPC practices in each respective region (New York, Ohio/Kentucky, Oklahoma, and Colorado).

General information about this opportunity
Last Known Status
Active
Program Number
93.646
Federal Agency/Office
Agency: Department of Health and Human Services
Office: Centers for Medicare and Medicaid Services
Type(s) of Assistance Offered
Cooperative Agreements
Program Accomplishments
Not Applicable.
Authorization
Section 1115a of the Social Security Act, as added by Section 3021 of the Patient Protection and Affordable Care Act (ACA), authorizes the Centers for Medicare and Medicaid Innovation (CMMI or the Innovation Center) to test innovative payment and service delivery models to reduce spending under Medicare, Medicaid, or CHIP, while preserving or enhancing the quality of care furnished to beneficiaries under those programs.
Who is eligible to apply/benefit from this assistance?
Applicant Eligibility
This project will ultimately benefit the primary care health professionals who participate in CPC and their patients. The aggregated data will be used by the primary care health professionals to improve care coordination and population health management, and to decrease costs. This project will also benefit payers and healthcare researchers, as well as the general public.
Beneficiary Eligibility
This project will ultimately benefit the primary care health professionals who participate in CPC and their patients. The aggregated data will be used by the primary care health professionals to improve care coordination and population health management, and to decrease costs. This project will also benefit payers and healthcare researchers, as well as the general public.
Credentials/Documentation
No Credentials or documentation are required. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.
What is the process for applying and being award this assistance?
Pre-Application Procedure
Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
Application Procedure
This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
Award Procedure
Applications will be forwarded to a review panel. The review panel will evaluate the proposals based on how well they address the evaluation criteria outlined in the FOA. Based on the advice of the review panel, the CMS selection official will approve the selected application and issue a Notice of Award. Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions. Applicants should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified by the review panel.
Deadlines
Contact the headquarters or regional office, as appropriate, for application deadlines.
Approval/Disapproval Decision Time
From 30 to 60 days.
Appeals
From 15 to 30 days. We will allow 30 day rework time for applications not approved.
Renewals
The budget and project period for each Cooperative Agreement will be 12 months from the date of award. The estimated budget and project period for the first round of awards is 12 months from the date of award with one non-competing continuation period.
How are proposals selected?
Applications must adhere to the format described in the FOA. The application must include:

•Project Abstract (not exceeding 1 page)
•Project Narrative (not exceeding 20 pages)
•Proposed Approach
•Organizational Capacity and Management
•Plan for Evaluation and Reporting
•Appendices

The applications will be evaluated based on how well they have addressed the above components, with emphasis on the applicant’s capacity for conducting data aggregation duties required by the program. This includes: evidence of prior relationships with payers and practices in the region, a demonstrated understanding of the data aggregation needs of health insurers and primary care practices in the region, and a clear plan of action on achievable objectives within one year and subsequent award years.
How may assistance be used?
All funds awarded should be expended only for carrying out approved projects in accordance with the intent of the cooperative agreement as stipulated in the notice of the award. Specifically, funds should be used toward establishing or expanding an existing data aggregation system that supports the following duties:

•Process and manipulate Medicare FFS administrative data, including claims files;
•Aggregate Medicare data with data from regional payers;
•Prepare reports, charts, and graphs that display healthcare data at the patient-level, with ability to group patients by payer, health care system, practice, care team, and provider. Healthcare data may include but is not limited to utilization, cost, diagnoses, and prescription medications. These reports should be available to all participating practices in the specified region, as well as to CMS and its contractor. These reports should include:
•Patient de-identified reports that can be shared with all participants;
•Patient-identifiable reports for practices aggregated with that of regional payers, as consistent with HIPPA privacy rules;
•Patient-identifiable reports on Medicare beneficiariesfor Medicare consumption based on data aggregated with that of regional payers, as consistent with HIPPA privacy rules.
What are the requirements after being awarded this opportunity?
Reporting
As part of the activities funded by these awards, the awardee must make reports available to all participating CPC practices in the specified region, as well as to CMS and its contractors. These reports should include:
•Patient de-identified reports that can be shared with all participants;
•Patient identifiable reports for practices based on data aggregated with that of regional payers, as consistent with HIPPA privacy rules;
•Patient-identifiable reports on Medicare beneficiaries for Medicare consumption based on data aggregated with that of regional payers, as consistent with HIPPA privacy rules. No cash reports are required. CMS plans to continuously monitor awardees through quarterly reporting requirements in order to ensure that the data aggregation services are being performed in line with the stated goals. Awardees must agree to cooperate with any Federal evaluation and monitoring of the activities funded by these cooperative agreements and provide quarterly and final (at the end of the cooperative agreement period) reports, as well as any additional reports required.

The awardee will be responsible for providing ongoing ad hoc status updates at the request of CMS program staff, as well as formal reports at regular intervals as described below:
•Quarterly Progress reports: Quarterly reports should be brief, summarize progress toward the goals outlined in the implementation plan, and should be submitted within 30 calendar days of the end of each quarter. The quarterly progress reports will include an overview of progress, analysis of challenges, discuss key lessons, and provide mitigation strategies for addressing barriers during implementation. The report should also detail how cooperative agreement funds were used for the past three-month period. This information shall be provided to CMS using the SF-424A form. CMS will use this information to monitor operations.
•Final Report: No later that 90 calendar days after the end of the cooperative agreement, the awardee shall submit a final report to CMS. The final report will summarize outcomes of the cooperative agreement, expenditures for all related activities, review key challenges and lessons learned, and discuss the future and sustainability of the data aggregation services built. The program requires expenditure reports monthly from the start date of the award. The expenditure report should include a narrative summary of all expenditures made using Federal funding. Performance will be monitored through Quarterly Progress Reports as described in Question 4 above.
Auditing
No audits are required for this program.
Records
Awardees are required to maintain proper records – including financial records, supporting documents, statistical records, and all other records pertinent to the program – for the duration of the award, and retain these for a minimum of three years. If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the three years, the records should be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular three year period, whichever is later.
Other Assistance Considerations
Formula and Matching Requirements
This program has no statutory formula.
Matching Requirements: Applicants must have secured commitments for matching funds from other sources.
This program does not have MOE requirements.
Length and Time Phasing of Assistance
N/A. Method of awarding/releasing assistance: quarterly.
Who do I contact about this opportunity?
Regional or Local Office
See Regional Agency Offices.
Headquarters Office
Leah Hendrick 7205 Windsor Blvd, Windsor Mill, Maryland 21244 Email: leah.hendrick@cms.hhs.gov Phone: 410-786-7397
Website Address
http://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/
Financial Information
Account Identification
75-0522-0-1-551.
Obligations
(Cooperative Agreements) FY 14 $0; FY 15 est $450,000; and FY 16 Estimate Not Available
Range and Average of Financial Assistance
The anticipated total funding per award, per budget period is $200,000 - $450,000.
Regulations, Guidelines and Literature
Not Applicable.
Examples of Funded Projects
Not Applicable.

 



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