In case you missed the announcement on November 14, The Centers for Medicare and Medicaid Services has come out with a big, game-changing grants program: the Innovation Challenge. Letters of intent are due in just a few weeks. This program is designed to engage all the creativity and ferment in health care and help drive it towards the triple aim: better care, better health, and lower costs. Its focus is broader than just Medicare. It includes Medicaid and SCHIP and gives extra points for improvements in the rest of health care.

In fact, the proposed point system for scoring is itself very interesting:

  • Model Design: 30 pts. Proposes an innovative approach to achieve better care, better health, and lower costs
  • Organizational Capacity: 25 pts. Demonstrates a history of operational success and realistic plans for implementation
  • Workforce: 15 pts. Demonstrates significant workforce impact
  • Sustainability and Finances: 20 pts. Offers a pathway to sustainability and lowers cost
  • Evaluation: 10 pts. Plans for self-evaluation to assess achievement of the triple aim

We don’t really know what they mean by any of these things yet, and I can’t find any responses to questions submitted at the various webinars or conference calls held to date. But in the meantime, check out these slides and this document for more information, and I’m sure we will learn more over time.

I think the materials look very promising. For example, specifically allowing the use of funds for training of new workers for the targeted models of care is a great advance over other demonstrations that simply assume that new workers for new models of care will spring forth like mushrooms after a rain. A focus on high-cost/high-risk populations, specifically including the frail elderly, should give geriatric experts the opportunity to show their special skills. The requirement for evidence of the benefits of innovative models will give an advantage to those who have worked in this field for so long. The program offers the possibility of support for critical infrastructure (such as IT) and sustainability through mechanisms such as service delivery contracts with ACOs or Medical Homes.

All applicants must submit brief Letters of Intent by December 19, 2011, and the full applications are due January 27, 2012. The final application will be long and complex – a 40-page limit with up to 30 pages of supplementary material, but the award amounts can be between $1,000,000 and $30,000,000. I put together an Excel spreadsheet of the application budget to offer a bit of help. I know that many grantees are interested, but I am afraid that at the end of the day, many will decide against applying.

For grantees used to either private philanthropy or NIH-style grants, this kind of cooperative agreement will seem strange. It will be very difficult to handicap one’s chances versus more familiar funding. There will no doubt be substantial organizational barriers from institutions unsure where their best interests lie. The requirements to claim clinical improvement within 6 months and cost reductions within 1 or 2 years will seem outlandish to the minds of careful, self-critical researchers. Trying to develop a model of financial sustainability other than a new covered benefit will be daunting at best. It will potentially gore some powerful oxen, since as we know, one man’s savings used to be another man’s income.

Nonetheless, I think it is vital that our grantees apply. The key question to me is, if not you, who? We all know that there are players from the commercial sector who will be applying. Some will be the very same players who were involved in the fiasco that was Medicare Health Support. Do you think that they have better evidence of what will improve care, better ideas about how to improve the health of the public, or more honest approaches to reducing the costs of care? If geriatric care experts like those we have supported for these many years cannot step up to this challenge to put their ideas into widespread practice and expand their work to a national stage, who will? Finally, while CMMI plans to run two rounds of the competition, there is no guarantee there will be a second round as they are not holding back funds if there are promising proposals in the first round. Moreover, as we also know, with Dr. Berwick’s departure as of December 2 the future is uncertain.

If there is anything we at the Foundation can do to be supportive, we want to know. Perhaps we could organize some pre-application peer reviews? Or, if there were some generally useful legal or business planning expertise we could make available to grantees, we could try to buy some consulting time. Of course, we'd be happy to critique proposals and offer letters of support ourselves (if you can fit them in your 30 pages).

If not you, who? If not now, when?