CMS RFI: CMMI Value-Based Care Technology Request for Information

“… CMMI has achieved a great deal of reusability in the last 10 years and has successfully launched 58 models since the Center’s inception. However, there are still gaps in the architecture and opportunities to improve the experience of all entities involved with models.

There are model-specific IT systems remaining.

In 2020, 43% of CMMI’s IT systems were model-specific systems. These systems were developed specifically for a model and not usable by other models. Since 2020, CMMI has retired 7 systems. 11% of the Center’s IT systems are now model-specific systems.

Individual model implementations are complex.

One model needs multiple systems, services, and operations from multiple contracts and CMS components. Model teams navigate a complex set of systems and processes to implement operations for a model. This creates complex implementation projects that CMMI must complete on the accelerated timeframes between model clearance and model go-live (often one year or less). Appendix B illustrates sample model implementations.

The user experience is fragmented.

Participants typically interact with several CMS systems to engage in a model. Additionally, many data exchanges with participants do not use health IT standards or take advantage of existing EHR capabilities. As a result, submitting data to CMS is often burdensome because organizations must take extra steps outside of their normal workflow and create custom capabilities to participate in models. This situation creates barriers to participation, increases provider burden, and misses opportunities to improve the beneficiary experience through care coordination.

There is duplicated participant data.

Multiple systems and contractors store and use participant lists. This situation increases the risk of incorrect business processing and increases costs. Appendix B includes an example of duplicated participant data.

Contractors manually perform critical business operations.

People at implementation contractors perform many of the most essential business functions for value-based care models. The contractors (a) acquire workspace in the IDR or CCW; (b) write SAS queries to extract data; (c) complete computations; and (d) create files in a desktop tool like Microsoft Excel. The model teams and contractors do not share code or data with each other.

These processes will be difficult to scale if the CMS actuary certifies models for expansion…”

“… Potential solutions have addressed a portion of needs.

CMMI regularly receives concepts from vendors and contractors. Each of these potential solutions has addressed only a portion of the Innovation Center’s need described in the next section. For example, new concepts suggested to the Innovation Center have:

• Focused on ACOs and not considered other model types such as State-based models;
• Suggested capabilities to share Innovation Center data with external entities, but did not address the need to collect data from participants; and
• Interacted with clinical data but did not address the payment functions of models.

CMMI started a pilot of a commercial software product for value-based care models. The pilot set out to prove that a commercial tool could support all innovative models and become a single platform for value-based care programs. Indeed, the product included promising features. However, CMMI stopped the pilot because:

1. The current state of participant data made it difficult to use the product efficiently.
2. The product could not replace enough current systems and processes to produce a Return on Investment…”

Outlined here are CNNI’s desired Results

More here.

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