WASHINGTON – The government will award up to $1 billion to fund innovative projects across the country that test creative ways to deliver high quality medical care and save money.

The Department of Health and Human Services launched the Health Care Innovation Challenge Nov. 14. The initiative will also give preference to projects that rapidly hire, train and deploy healthcare workers.

The Health Care Innovation Challenge will award up $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs.

The objectives of this initiative are to:

• Engage a broad set of innovation partners to identify and test new care delivery and payment models that originate in the field and that produce better care, better health, and reduced cost through improvement for identified target populations.
• Identify new models of workforce development and deployment and related training and education that support new models either directly or through new infrastructure activities.
• Support innovators who can rapidly deploy care improvement models (within six months of award) through new ventures or expansion of existing efforts to new populations of patients, in conjunction (where possible) with other public and private sector partners.

Awards will range from approximately $1 million to $30 million for a three-year period. Applications are open to providers, payers, local government, public-private partnerships and multi-payer collaboratives. Each grantee project will be monitored for measurable improvements in quality of care and savings generated.

The Health Care Innovation Challenge will encourage applicants to include new models of workforce development and deployment that efficiently support their service delivery model proposal. Enhanced infrastructure to support more cost effective system-wide function is also a critical component of health care system transformation, and applicants are encouraged to include this as an element of their proposals.
Application Information

Potential applicants must submit a letter of intent (LOI) by December 19, 2011 in order to be eligible for a funding award. Please refer to the FOA for more information on the LOI process. When you’re ready, click here to submit your LOI.

All applications must be submitted electronically through www.grants.gov. Applicants are strongly encouraged to use the review criteria information provided in the “Application Review Information” section in the funding opportunity announcement (FOA), to help ensure that the proposal adequately addresses all the criteria that will be used in evaluating the proposals.

Note: All prime awardees must provide a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number in order to be able to register in the Federal Funding Accountability and Transparency Subaward Reporting System (FSRS) as a prime award user. Further, registration with the Central Contracting Registration (CCR) at www.ccr.gov is also required in order to apply. Please refer to the FOA for further application information.
Important Dates

* Letter of Intent: December 19, 2011
* Applications are due, January 27, 2012
* Anticipated Award Date: March 30, 2012

**CMS Innovation Center staff will be hosting an informational webinar on the Health Care Innovation Challenge for all interested individuals and organizations on Thursday, November 17, 2011 from 2:00-3:30pm ET. Staff will provide an overview of the initiative and be available to answer questions from the audience.

Please visit the webinar site to join. No advance registration is required.

Participants wishing to only listen to audio may dial 888-567-1602 or 201-604-5049 and request “Center for Medicare & Medicaid Innovation Webcast” (no passcode). Reminder, participants will only be able to ask questions via chat feature online.

A recording will be available following the webinar.

For more information, please direct your questions to InnovationChallenge@cms.hhs.gov.

To develop the public health emergency text message content, HHS experts worked with state and local agencies. The content, approved by subject matter experts, complements 30-second public service announcements for radio and television available through the Centers for Disease Control and Prevention. The text messages cover a wide range of actions people can take to protect their health.

Messages are limited to 115 characters or fewer including spaces. Emergency responders can use the messages as they are or tailor the messages based on specific local needs. The toolkit currently features text messages relevant to hurricanes, floods and earthquakes.

Local and state agencies register their interest in using the toolkit by providing contact information to HHS, so they can receive alerts and updates as the content expands to include health tips for additional types of disasters. More than 400 agencies have registered so far. Agencies register by email: publichealthemergency@hhs.gov.

The text message toolkit is a collaborative effort of five U.S. Department of Health and Human Services’ divisions: the Office of the Assistant Secretary for Preparedness and Response, the Office of the Assistant Secretary for Public Affairs, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Substance Abuse and Mental Health Services Administration.

The corrections department estimates that nearly half of parolees who are supervised end up being returned to prison for various violations.

“It is therefore probable that some of the discharged parolees inappropriately placed on non-revocable parole would have violated their parole conditions and returned to prison, had they been on supervised parole,” the report concludes.

The report comes on the heels of Monday’s U.S. Supreme Court decision requiring California’s prison population of more than 143,000 to be reduced by 33,000 inmates in the next two years.

Using the 15% error rate they found in their sample, investigators estimated that more than 450 violent inmates had been released during the first seven months of the program, the time period they reviewed. Prison officials have disputed the findings, saying they had corrected some of the computer problems discovered by the inspector general. The error rate is now 8%, the inspector general report says.

Gov. Jerry Brown’s plan to address overcrowding would shift tens of thousands of low-level offenders from prison to county custody. Counties would also supervise most low-risk parolees, like those in the non-revocable program.

>> Download the White paper about how to reduce recidivism.

A Notice of Proposed Rulemaking concerning the accounting of disclosures requirement under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, is available for public comment.

The proposed rule would give people the right to get a report on who has electronically accessed their protected health information.

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) is proposing changes to the Privacy Rule, pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH is part of the American Recovery and Reinvestment Act of 2009.

“This proposed rule represents an important step in our continued efforts to promote accountability across the health care system, ensuring that providers properly safeguard private health information,” said OCR Director Georgina Verdugo. “We need to protect peoples’ rights so that they know how their health information has been used or disclosed.”

People would obtain this information by requesting an access report, which would document the particular persons who electronically accessed and viewed their protected health information. Although covered entities are currently required by the HIPAA Security Rule to track access to electronic protected health information, they are not required to share this information with people.

The proposed rule requires an accounting of more detailed information for certain disclosures that are most likely to affect a person’s rights or interests. The proposed changes to the accounting requirements provide information of value to individuals while placing a reasonable burden on covered entities and business associates.

People may now read the proposed rule at: http://www.federalregister.gov/ and submit comments to http://www.regulations.gov/ (search for Proposed Rule) through August 1, 2011.

People who believe a covered entity has violated their (or someone else’s) health information privacy rights or committed another violation of the HIPAA Privacy or Security Rules, may file a complaint with OCR at http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. Additional information about OCR’s enforcement activities can be found at http://www.hhs.gov/ocr.

“This article brings us much more up-to-date, both in our confidence regarding the overwhelming evidence of the benefits of adoption and use of HIT, and also in our understanding of problem areas that still need to be addressed, “ said David Blumenthal, M.D., the national coordinator for HIT and one of the authors of the review. “This review is important because it helps us correct for the lag in evidence that occurs naturally in the dynamic HIT field, where changes in technology and accelerating adoption cause the old literature to become quickly outdated.”

The review included articles published from July 2007 up to February 2010, following up on earlier reviews of articles from 1995 to 2004 and from 2004 to 2007. This latest review initially surveyed more than 4,000 peer-reviewed articles, of which 154 were found qualified for the parameters of the study, a number similar to the previous efforts.

The current review found positive results in 96 of the articles (62 percent), and mixed but predominantly positive results in 46 other articles (30 percent). Ten articles were found to have negative or mixed-negative results. In addition to quality and efficiency of care, the authors categorized additional outcomes including access to care, preventive care, care process, patient safety, and provider or patient satisfaction.

The review also reflected a new balance of evidence between HIT “leader” organizations and other entities, especially smaller medical practices. In previous years, much evidence has come from the “leaders.” The current review shows increased evidence of benefits for others as well.

“These new findings are very significant in helping to confirm that our Nation has made the right choice in moving aggressively toward adoption of health information technology,” said Donald Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, as much as $27 billion Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

Positive results highlighted in the article include:

* One study found that at three New York City dialysis centers, patient mortality decreased by as much as 48 percent while nurse staffing decreased by 25 percent in the three years following implementation of EHRs.
* In an inpatient study, a clinical decision support tool designed to decrease unnecessary red blood cell transfusions reduced both transfusions and costs, with no increase in patient length-of-stay or mortality.
* Another study addressing HIT in 41 Texas hospitals found that hospitals with more advanced HIT had fewer complications, lower mortality and lower costs than hospitals with less advanced HIT.

Negative findings in the study were most often associated with provider or staff satisfaction related to difficulties in the process of transitioning from paper-based to electronic-based records and care. According to the article, these findings “highlight the need for studies that document the challenging aspects of implementing HIT more specifically and how these challenges might be addressed,” such as through strong leadership or staff participation when adopting and implementing HIT.

Reflecting on the findings, Surgeon General Regina Benjamin, M.D., said, “My own personal experience in switching my practice from paper to EHRs showed that the change requires some initial effort; however, it did not interrupt work flow in the clinic. The results are better care for patients and new opportunities for the physician and staff to improve quality outcomes.” Dr. Benjamin switched to EHRs in her Gulf Coast Alabama family practice after two hurricanes and a fire destroyed the clinic’s paper records.

At the Agency for Healthcare Research and Quality, where research into health informatics has been supported since 1968, agency Director Carolyn Clancy, M.D., called attention to the importance of rapid information feedback and current evidence as the Nation pursues HIT implementation. “As we have known, and this new review of the available literature shows, HIT holds tremendous potential to improve health care quality. It is important that we continue to use experience from the field and scientific evidence to guide our efforts to improve the quality and safety of health care for all Americans.”

The article, “The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results,” is available on www.healthit.gov

The company said the application is free and can be downloaded through the Apple apps store.

According to WellCare Today, the HealthAssist SmartPhone application helps users, especially those with chronic diseases, with the following features:

– CalendarAlert provides the user with a scheduled text reminder for each medication

– RefillAlert provides the user with a reminder of when they need to request a prescription refill

– HealthAlert provides the user each month with “condition- related:”

– Breaking-news headlines

– Health management articles

– Dialogue forums or chat rooms

– Clinical trials

– EMRAlert provides the user with a way to store and update a private electronic medical record

WellCare Today (WCT) specializes in providing improving healthcare outcomes via applications on smart phones. By texting application users medication reminders and educating patients via web links to condition-related articles and social media sites, WCT said it expects to improve chronic disease outcomes and reduce healthcare costs. The applications are free of charge to the user and sponsors get condition-related branding opportunities.

For their part, patients report increasing difficulty getting a doctor’s appointment. In 2007, about 35 percent of patients said they could not get an appointment soon enough — up from 23 percent in 1997, according to the nonprofit Center for Studying Health System Change. That problem could worsen as an additional 32 million Americans begin to gain health coverage in 2014 under the new health law.

ZocDoc, which started in New York City in 2007 and entered the Washington, D.C., market earlier this year, also offers its online doctor scheduling in Chicago and Dallas. It’s hoping to add doctors in Boston, Los Angeles, Houston and Philadelphia. CEO Cyrus Massoumi says he envisions ZocDoc doing for doctor and dentist appointments what opentable.com has done for online restaurant reservations.

Massoumi, a former consultant with McKinsey & Co. and son of a West Palm Beach hand surgeon, says he came up with the idea for the service after his ear drum burst and it took him four days to find a doctor in New York to help him. Funders of the privately held company include Jeff Bezos, CEO of Amazon.com, and The Founders Fund, an early financier of Facebook.

About 40 percent of ZocDoc appointments take place within a day of booking. After an appointment is made online, the doctor’s office confirms it by email and then ZocDoc sends electronic reminders. Nearly 85 percent of appointments made on ZocDoc are new patients.

Patients pay nothing. Doctors pay about $250 a month to be listed. While the company won’t say how many doctors it has signed up, a review of the web site shows it has hundreds of doctors and dentists in each market.

Dr. Christopher Mesick, examines a patient in Washington. More doctors are offering online scheduling thru sites like www.zocdoc.com. Patients can see doctors, appointment calendars and identify those that take their insurance and are conveniently located (Jack Gruber/USA TODAY)

Massoumi says the company has attracted doctors of different ages and experience. The company confirms a doctor’s professional membership, board certification and license. The website lists the providers’ education, hospital affiliations, language spoken and professional memberships. It also has reviews by ZocDoc patients.

Dr. Roland Goertz, president of the American Academy of Family Physicians, says he sees little downside to allowing patients to book appointments online. “I think any tools that make an office practice more efficient to take care of a large number of patients will be welcome,” he says.

Younger patients, he says, expect services like online scheduling because they are used to using the Internet for most of their consumer needs. In 2011, Goertz plans to add an online scheduling option at his own practice in Waco, Texas, at least for existing patients.

One other company that helps people to schedule appointments online, Health In Reach, started in September but is only marketing the feature to new patients in Los Angeles for now. CEO Scott Sangster says his company is paid only when the doctor gets an appointment. He would not reveal the fee. To reduce the no-show rates, patients must pay at least a portion of their insurance co-payment online ahead of the appointment.

Some well known health systems have moved to online scheduling. Kaiser Permanente, the large integrated health system based in Oakland, Calif., says last year about 5.5 percent of its doctor appointments, or 1.8 million, were booked online.

The Cleveland Clinic has allowed existing and new patients to make online appointment requests for three years. It has just begun a pilot program to allow existing patients to see the available appointments for some doctors. “This is a valuable tool which patients demand today because it adds to the patient experience,” says Dr. Rami Boutros, interim managing director of the Cleveland Clinic. “If it’s 11 at night, patients can check to see if there is an opening tomorrow.”

For physicians, online appointments are good business. Dave Behler, practice administrator at Feldman E.N.T. Group where Clint Morrison was treated, says ZocDoc has brought the 10-doctor practice hundreds of appointments since the service began in February. “Our phone system can be difficult to get through,” he says. “This takes the phone call out of the equation.”

http://www.npr.org/templates/story/story.php?storyId=130833741