Cmmi, Uncategorized

Cmmi

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The Center for Medicare and Medicaid Innovation (CMMI; also known as the CMS Innovation Center) is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation. CMS provides healthcare coverage to more than 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.

“The center is to test innovative payment and delivery system models that show important promise for maintaining or improving the quality of care in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while slowing the rate of growth in program costs”. The center “is to give priority to twenty models specified in the law, including medical homes, all-payer payment reform, and arrangements that transition from fee-for-service reimbursement to global fees and salary-based payment”. It is “intended to overcome antireform inertia by creating a mechanism for the diffusion of successful pilot programs” without requiring Congressional approval.

If a CMMI pilot model is considered successful, the Secretary of Health and Human Services may expand its duration and scope. To be considered a successful test, a model must meet three criteria:

  1. The Secretary determines that such expansion is expected to— (A) reduce spending under the applicable title without reducing the quality of care; or (B) improve the quality of patient care without increasing spending;
  2. The Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce (or would not result in any increase in) net program spending under the applicable titles; and
  3. The Secretary determines that such expansion would not deny or limit the coverage or provision of benefits under the applicable title for applicable individuals.

Since its founding, CMMI has produced three models that have been certified for expansion based on meeting the above criteria: the Pioneer Accountable Care Organization (ACO) Model and the Medicare Diabetes Prevention Program, and Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT).

Agreement Management (AM)

  • A Project Management process area at Maturity Level 2

Purpose

The purpose of Agreement Management (AM) is to ensure that the supplier and the acquirer perform according to the terms of the supplier agreement.

Specific Practices by Goal

  • SG 1 Satisfy Supplier Agreements
    • SP 1.1 Execute the Supplier Agreement
    • SP 1.2 Monitor Selected Supplier Processes
    • SP 1.3 Accept the Acquired Product
    • SP 1.4 Manage Supplier Invoices

Capacity and Availability Management (CAM)

  • A Support process area at Maturity Level 3

Purpose

The purpose of Capacity and Availability Management (CAM) is to ensure effective service system performance and ensure that resources are provided and used effectively to support service requirements.

Specific Practices by Goal

  • SG 1 Prepare for Capacity and Availability Management
    • SP 1.1 Establish a Capacity and Availability Management Strategy
    • SP 1.2 Select Measures and Analytic Techniques
    • SP 1.3 Establish Service System Representations
  • SG 2 Monitor and Analyze Capacity and Availability
    • SP 2.1 Monitor and Analyze Capacity
    • SP 2.2 Monitor and Analyze Availability
    • SP 2.3 Report Capacity and Availability Management Data

Causal Analysis and Resolution (CAR)

  • A Support process area at Maturity Level 5

Purpose

The purpose of Causal Analysis and Resolution (CAR) is to identify causes of selected outcomes and take action to improve process performance.

Specific Practices by Goal

  • SG 1 Determine Causes of Selected Outcomes
    • SP 1.1 Select Outcomes for Analysis
    • SP 1.2 Analyze Causes
  • SG 2 Address Causes of Selected Outcomes
    • SP 2.1 Implement Action Proposals
    • SP 2.2 Evaluate the Effect of Implemented Actions
    • SP 2.3 Record Causal Analysis Data

Configuration Management (CM)

  • A Support process area at Maturity Level 2

Purpose

The purpose of Configuration Management (CM) is to establish and maintain the integrity of work products using configuration identification, configuration control, configuration status accounting, and configuration audits.

Specific Practices by Goal

  • SG 1 Establish Baselines
    • SP 1.1 Identify Configuration Items
    • SP 1.2 Establish a Configuration Management System
    • SP 1.3 Create or Release Baselines
  • SG 2 Track and Control Changes
    • SP 2.1 Track Change Requests
    • SP 2.2 Control Configuration Items
  • SG 3 Establish Integrity
    • SP 3.1 Establish Configuration Management Records
    • SP 3.2 Perform Configuration Audits

Decision Analysis and Resolution (DAR)

  • A Support process area at Maturity Level 3

Purpose

The purpose of Decision Analysis and Resolution (DAR) is to analyze possible decisions using a formal evaluation process that evaluates identified alternatives against established criteria.

Organizational Process Performance (OPP)

  • A Process Management process area at Maturity Level 4

Purpose

The purpose of Organizational Process Performance (OPP) is to establish and maintain a quantitative understanding of the performance of selected processes in the organization’s set of standard processes in support of achieving quality and process performance objectives, and to provide process performance data, baselines, and models to quantitatively manage the organization’s projects.

Specific Practices by Goal

  • SG 1 Establish Performance Baselines and Models
    • SP 1.1 Establish Quality and Process Performance Objectives
    • SP 1.2 Select Processes
    • SP 1.3 Establish Process Performance Measures
    • SP 1.4 Analyze Process Performance and Establish Process Performance Baselines
    • SP 1.5 Establish Process Performance Models

Organizational Training (OT)

  • A Process Management process area at Maturity Level 3

Purpose

The purpose of Organizational Training (OT) is to develop skills and knowledge of people so they can perform their roles effectively and efficiently.

Specific Practices by Goal

  • SG 1 Establish an Organizational Training Capability
    • SP 1.1 Establish Strategic Training Needs
    • SP 1.2 Determine Which Training Needs Are the Responsibility of the Organization
    • SP 1.3 Establish an Organizational Training Tactical Plan
    • SP 1.4 Establish a Training Capability
  • SG 2 Provide Training
    • SP 2.1 Deliver Training
    • SP 2.2 Establish Training Records
    • SP 2.3 Assess Training Effectiveness

Product Integration (PI)

  • An Engineering process area at Maturity Level 3

Purpose

The purpose of Product Integration (PI) is to assemble the product from the product components, ensure that the product, as integrated, behaves properly (i.e., possesses the required functionality and quality attributes), and deliver the product.

Specific Practices by Goal

  • SG 1 Prepare for Product Integration
    • SP 1.1 Establish an Integration Strategy
    • SP 1.2 Establish the Product Integration Environment
    • SP 1.3 Establish Product Integration Procedures and Criteria
  • SG 2 Ensure Interface Compatibility
    • SP 2.1 Review Interface Descriptions for Completeness
    • SP 2.2 Manage Interfaces
  • SG 3 Assemble Product Components and Deliver the Product
    • SP 3.1 Confirm Readiness of Product Components for Integration
    • SP 3.2 Assemble Product Components
    • SP 3.3 Evaluate Assembled Product Components
    • SP 3.4 Package and Deliver the Product or Product Component

Project Monitoring and Control (PMC)

  • A Project Management process area at Maturity Level 2

Purpose

The purpose of Project Monitoring and Control (PMC) is to provide an understanding of the project’s progress so that appropriate corrective actions can be taken when the project’s performance deviates significantly from the plan.

Specific Practices by Goal

  • SG 1 Monitor the Project Against the Plan
    • SP 1.1 Monitor Project Planning Parameters
    • SP 1.2 Monitor Commitments
    • SP 1.3 Monitor Project Risks
    • SP 1.4 Monitor Data Management
    • SP 1.5 Monitor Stakeholder Involvement
    • SP 1.6 Conduct Progress Reviews
    • SP 1.7 Conduct Milestone Reviews
  • SG 2 Manage Corrective Action to Closure
    • SP 2.1 Analyze Issues
    • SP 2.2 Take Corrective Action
    • SP 2.3 Manage Corrective Actions

Project Planning (PP)

  • A Project Management process area at Maturity Level 2

Purpose

The purpose of Project Planning (PP) is to establish and maintain plans that define project activities.

Specific Practices by Goal

  • SG 1 Establish Estimates
    • SP 1.1 Estimate the Scope of the Project
    • SP 1.2 Establish Estimates of Work Product and Task Attributes
    • SP 1.3 Define Project Lifecycle Phases
    • SP 1.4 Estimate Effort and Cost
  • SG 2 Develop a Project Plan
    • SP 2.1 Establish the Budget and Schedule
    • SP 2.2 Identify Project Risks
    • SP 2.3 Plan Data Management
    • SP 2.4 Plan the Project’s Resources
    • SP 2.5 Plan Needed Knowledge and Skills
    • SP 2.6 Plan Stakeholder Involvement
    • SP 2.7 Establish the Project Plan
  • SG 3 Obtain Commitment to the Plan
    • SP 3.1 Review Plans that Affect the Project
    • SP 3.2 Reconcile Work and Resource Levels
    • SP 3.3 Obtain Plan Commitment

Process and Product Quality Assurance (PPQA)

  • A Support process area at Maturity Level 2

Purpose

The purpose of Process and Product Quality Assurance (PPQA) is to provide staff and management with objective insight into processes and associated work products.

Specific Practices by Goal

  • SG 1 Objectively Evaluate Processes and Work Products
    • SP 1.1 Objectively Evaluate Processes
    • SP 1.2 Objectively Evaluate Work Products
  • SG 2 Provide Objective Insight
    • SP 2.1 Communicate and Resolve Noncompliance Issues
    • SP 2.2 Establish Records.

Quantitative Project Management (QPM)

  • A Project Management process area at Maturity Level 4

Purpose

The purpose of the Quantitative Project Management (QPM) process area is to quantitatively manage the project to achieve the project’s established quality and process performance objectives.

Specific Practices by Goal

  • SG 1 Prepare for Quantitative Management
    • SP 1.1 Establish the Project’s Objectives
    • SP 1.2 Compose the Defined Processes
    • SP 1.3 Select Subprocesses and Attributes
    • SP 1.4 Select Measures and Analytic Techniques
  • SG 2 Quantitatively Manage the Project
    • SP 2.1 Monitor the Performance of Selected Subprocesses
    • SP 2.2 Manage Project Performance
    • SP 2.3 Perform Root Cause Analysis
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