By Rebecca Adams, CQ HealthBeat Associate Editor
October 18, 2010 -- Top officials at the Centers for Medicare and Medicaid Services (CMS) on Monday outlined their framework for a new office that will distribute $10 billion over a decade in grants aimed at updating the nation's health care system.
"It's taking more of my time to think through CMMI than almost anything else I'm doing right now," said CMS Administrator Donald M. Berwick, referring to the new Center for Medicare and Medicaid Innovation. Berwick was speaking at an event sponsored by the Engelberg Center for Health Care Reform at the Brookings Institution.
The agency is looking for proposals that will improve health care delivery, improve public health and reduce medical costs. The center is now ramping up and is expected to be fully operational after the first of the year.
"The key point is the need to address all three," said CMMI Director Richard Gilfillan, who also spoke at the event on innovation. "You can expect to see rigorous attention to understanding the data and outcomes along all three of those dimensions."
The two men, who spoke separately during the three-hour forum, referred to the focus of this new center as the "triple aim."
Berwick explained the goals in more detail. Center officials want health systems and companies that are seeking grants to propose new ways to improve care for individual patients, support the overall health of Americans—unrelated to the services that patients get in hospitals, and reduce costs "without harming a hair on anyone's head," Berwick said.
Within the first category, Berwick advised applicants to focus on six areas: improving safety, offering effectiveness through such means as avoiding overuse and underuse of medical services, giving patients information to help them choose and control their own care, acting in a timely manner, reducing waste and closing the racial and socioeconomic disparities that exist among different groups in the United States.
The second goal would support public health. Berwick noted that when you compare the health of people around the world, the provision of medical services only accounts for about 10 percent of the variation. Other important factors are individuals' lifestyles, environment, behavior choices, and genetics.
"If we're serious about producing the end result we want, I don't think we have the privilege of saying we shouldn't be a good partner in generating good health," Berwick said, meaning he wants to see these grants encompass more than the traditional CMS role in financing medical services.
Lowering costs is also important, given that Medicare expenditures totaled more than $500 billion in 2009.
"It is about the reduction of costs through improvement," Berwick said.
Gilfillan said, half-jokingly, that when people ask what is on his mind as he sets up the center, his main concern is "speed" in this world of fast-paced technology.
Gilfillan is well-positioned to lead the efforts, Berwick said. Gilfillan is a physician who ran the Geisinger Health Plan in Pennsylvania from 2005 to 2009. The plan is part of Geisinger Health System, which many health policy analysts hold up as a nation model for delivering high-quality, affordable care.