As the Obama administration nears its final months, the Center for Medicare and Medicaid Innovation (CMMI) is racing to implement as many new programs as it can manage. CMMI was created by the Affordable Care Act and given $10 billion to spend over ten years to test different health care payment and delivery reforms. Thirty-four initiatives have been announced or implemented by CMMI and the agency expects to continue to roll out new initiatives until the last days of the administration. Indeed, some are beginning to worry that the various reform initiatives coming out of CMMI specifically and the Centers for Medicare and Medicaid Services more broadly have begun to overlap with each other, thereby making evaluation of the different models more difficult.
A new article in Governing Magazine describes Non-Emergency Medical Transportation (NEMT) as one of the biggest challenges facing low-income consumers. The federal government requires transportation reimbursement for NEMT for Medicaid recipients, and for good reason. If patients can’t get to regular doctor appointments their medical conditions can worsen, resulting in expensive complications. But despite the importance of this service, many states struggle to provide it adequately, leaving sick and vulnerable patients stranded and forced to resort to emergency rooms or forego care completely.
As policymakers, advocates and experts struggle to identify quality measures that reflect what is important to patients, a fairly straightforward idea is being tested in the U.K.: measuring the amount of time a patient spends at home at the end of life. Most dying patients indicate that they want to spend the end of their lives at home, not in a hospital or other institution. Accordingly, a provider group in Great Britain has begun measuring its success by how long they are able to keeping people living in their homes.