Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare. These Medicare-Medicaid enrollees are among the most fragile and chronically ill individuals served by the programs. Research found that approximately 45 percent of hospitalizations among Medicare-Medicaid enrollees receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion.
“We are excited about this partnership and the programs these seven organizations are putting in place to work with nursing facilities to ensure the best possible care for their residents.” said Acting Administrator Marilyn Tavenner. “We view this initiative and the enhanced level of collaboration it will generate among a variety of providers as the key to reducing costly and avoidable hospitalizations for this population that often has the most complex health care needs.”
Through the Initiative, CMS will partner with seven organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and State Medicaid programs to provide better quality of care in nursing facilities.
Implementation of the initiative will begin later this year at 145 nursing facilities in seven states in partnership with the following organizations:
· Alabama Quality Assurance Foundation (Alabama)
· Alegent Health (Nebraska)
· The Curators of the University of Missouri (Missouri)
· Greater New York Hospital Foundation, Inc. (New York)
· HealthInsight of Nevada (Nevada)
· Indiana University (Indiana)
· UPMC Community Provider Services (Pennsylvania)
All selected organizations will have on-site staff to partner with the existing nursing facility staff to provide preventive services as well as improve assessments and management of medical conditions. Participants will also work toward more seamless beneficiary transitions of care, and leverage use of emerging technologies, among many other activities. Each model will be subject to a rigorous external evaluation.
The Initiative will be run collaboratively by the CMS Medicare-
Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve health care quality and reduce costs in the Medicare and Medicaid programs. CMS issued a Request for Applications on March 15, 2012. More information about this initiative is available at: http://innovations.cms.gov/initiatives/rahnfr/.
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