To better inform its multi-stakeholder strategy for engagement with key Medicare policy-makers, ACCP is actively seeking input and feedback from members who have been engaged in practice within the Center for Medicare and Medicaid Innovation (CMMI). If you or your colleagues have experience working with CMMI, let our Washington, D.C., team know by contacting [email protected].
CMMI Background
ACCP’s advocacy work to amend Section 1861 of the Social Security Act to establish Medicare payment and coverage for qualified clinical pharmacists working under collaborative practice structures goes beyond simply seeking “provider status.” For almost 10 years, the College has sought to strengthen and expand efforts to test innovative approaches to integrating comprehensive medication management (CMM) through Medicare alternative payment models (APMs) and building relationships with physician groups, other provider and specialty organizations, private payers, and other key stakeholders to advance CMMI initiatives.
CMMI (or the “Innovation Center”) was established under the Affordable Care Act (ACA or “Obamacare”) in 2010 to test innovative payment and service delivery models for individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. CMMI’s goals are to:
- Improve patient care
- Lower costs
- Better align payment systems to promote patient-centered practices
CMMI drives practice transformation through APMs, which reward health care providers for delivering high-quality and cost-efficient care. APMs can apply to a specific:
- Health condition, like end-stage renal disease
- Care episode, like joint replacement
- Provider type, like primary care providers
- Community, like rural areas
- Innovation within Medicare Advantage or Medicare Part D
Examples of Ongoing CMMI Models
To advance opportunities for clinical pharmacists providing direct patient care services that ensure medication optimization, it is important for pharmacists to understand the opportunities available in evolving value-based payment models and to align medication optimization with the specific goals and incentives of these models. Many ACCP staff or members are already actively engaged with the following CMMI initiatives:
Next Steps
CMMI’s increasing recognition of CMM is another example of ACCP’s incremental progress in helping to advance clinical pharmacists as essential team members in effective integrated primary care.
ACCP also remains focused on efforts on Capitol Hill to educate lawmakers about innovative solutions to modernize Medicare, including coverage for CMM services. However, in devoting resources to support the advancement of pharmacists’ services across multiple payers and settings, ACCP’s strategy recognizes that entities such as CMMI exist precisely to pilot the integrated, advanced APMs the College endorses. Hence, ACCP is committed to working with thoughtful leaders across the political spectrum to advance an evidence-based approach to developing, positioning, and advancing clinical pharmacists.