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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)

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

Capacity and Availability Management (CAM)

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

Causal Analysis and Resolution (CAR)

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

Configuration Management (CM)

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

Decision Analysis and Resolution (DAR)

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)

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

Organizational Training (OT)

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

Product Integration (PI)

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

Project Monitoring and Control (PMC)

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

Project Planning (PP)

Purpose

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

Specific Practices by Goal

Process and Product Quality Assurance (PPQA)

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

Quantitative Project Management (QPM)

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

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