#CMS TRIPLE AIM HOW TO#
#CMS TRIPLE AIM DRIVER#

The passage of the Patient Protection and Affordable Care Act (PPACA), in 2010, brought a renewed interest in achieving the “‘Triple Aim’: improving the individual experience of care improving the health of populations and reducing the per capita costs of care for populations.” While achieving the Triple Aim may seem far reaching to some, 38 states were awarded funding from the Centers for Medicare and Medicaid Services (CMS), between 20, to either design, test, or implement health care delivery systems that deliver better care, improve quality, and reduce health care costs. While the debates will continue, many states are taking initiatives to develop state health care delivery systems that states hope will, or have led, to reductions in health care costs, in addition to improving quality of care and the health of their population with any one of these states possibly having the answer to transforming health care. health care system, is continuously being debated at both a national and state level, and has been for decades.

#CMS TRIPLE AIM HOW TO#

Controlling the rising costs of healthcare, along with how to reform the U.S. While one can debate what has caused health care costs to rise year after year, the fact remains that health care costs are projected to continue to rise. , CMS’s Office of the Actuary has predicted that national health care spending will grow by 5.5 percent for each year from 2017-2026. In 2017 national healthcare spending reached $3.5 trillion dollars, the per capita was $10,739, and the largest percentage of this money was spent on hospital services.

As Boughn sees it, it won't be a hard problem to overcome, given the short term focus – it will help define the right modules to direct suppliers and vendors to interface with the big data warehouses.The cost of health care in the United States has soared to astronomical amounts that are unsustainable.

The challenge will be getting states and vendors to work together to anticipate the right modular fit for the program. 'This is the CMS saying the rules have fundamentally changed and the states need to step up to the plate to get this to work because Medicaid is too important,' she said. Medicaid needs to focus on the short term rather than the long term, Boughn said. In fact, CMS is putting that responsibility into the hands of the states to make the definitions for short-term changes. 'This final rule is crucial for the CMS' efforts to modernize state eligibility systems to make real-time, accurate eligibility determinations and promote enrollment of eligible low-income people in Medicaid and CHIP,' she added.Įffective January 1, the ruling will also no longer approve the 'big bang' or wholesale Medicaid Management Information Systems. This is a significant departure from the past, Boughn noted. Each department will establish its own system. The system doesn't need to wholly function for changes to go into effect. But what's most important, Boughn says, is what CMS is accomplishing through its modular system. The 90/10 ruling permanently extends funding of Medicaid's E & E systems.

#CMS TRIPLE AIM DRIVER#

'And CMS feels like Medicaid is really a key driver for what providers need to achieve Triple Aim and they want to support the states in this area,' she added. It's not getting us the results that we want,' Boughn said.

'I feel this regulation is CMS saying, we don't think the way that we've done it in the past is effective. Perhaps one of the biggest changes is retiring outdated systems and transitioning into more modernized technology.Ĭognosante executive and former CMS CIO Julie Boughn, talked to Healthcare IT News about the ruling and its effects on Medicaid and the overall healthcare system. This new funding will implement initiatives, such as automated applications and renewals, efficient claims processing and integrated human services programs. Specifically, federal funding is increased from 50 to 90 percent for new eligibility and enrollment systems and Medicaid Management Information Systems. The ruling is just one of the latest efforts by CMS to support states attempting to modernize and develop more effective Medicaid IT systems. CMS recently passed the 90/10 final rule, extending the 2011 regulation on federal funding for Medicaid Eligibility systems.

Cms triple aim