Starting late last year the Center for Medicare and Medicaid Innovation, under the authority of the Affordable Care Act, announced an Innovation Challenge grants program aimed at supporting good ideas from institutions around the country that could meet the triple aim: improving care, improving population health, and reducing costs. We tried to encourage applicants from the aging and health community, consulted on several applications, and wrote letters of support for others. We are very excited to see the final set of 81 winners, just announced on Friday, joining the 26 winners selected in May. You can view summaries of the awards in this document: http://www.innovations.cms.gov/Files/x/HCIA-Project-Profiles.pdf.

Many of the projects advance issues that we have pursued for many, many years. Five or six projects aim at improving primary care for complex, chronically ill Medicare beneficiaries--one of our long-term objectives--using approaches such as patient-centered medical homes or community care teams. Several projects aim specifically at reducing hospital readmissions. Two projects focus on the special needs of older people with Alzheimer's disease. Although there are scores of exciting projects, we want to highlight several that relate directly to the work of our grantees:

1. Institute for Clinical Systems Improvement (ICSI)
Project title: “Care management of mental and physical co-morbidities: a Triple Aim bulls-eye"

The AIMS Center (Advancing Integrated Mental Health Solutions) at the University of Washington is one of several groups partnering with ICSI on this $17.9 million grant that will improve care delivery and outcomes for high-risk patients with depression and diabetes or cardiovascular disease. Led by Beeson Scholar and long-time grantee Jurgen Unutzer, AIMS’s approach is based on Unutzer’s IMPACT depression care program. ICSI spread the IMPACT model through the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) program, jumpstarted with dissemination funds from the John A. Hartford Foundation. For more information, view the press release.

2. Providence Portland Medical Center
Project Title: “Redesigning service delivery through the Tri-County Health Commons”

This Coordinated Care Organization (CCO), designed to integrate care delivery for Medicaid and Medicare/Medicaid dual-eligible beneficiaries, represents cooperation among many health services and health organizations in Portland, Oregon. The project, funded at $17.3 million, draws heavily on the work of the Care Management Plus team led by David Dorr of Oregon Health & Science University and was influenced by Eric Coleman’s Care Transitions Intervention. David Labby, MD, the interim chief medical officer for the Tri-County Medicaid Collaborative and grant project director, is a senior mentor for the the Hartford and Atlantic Philanthropies-funded Practice Change Fellows program. See the press release for more information.

3. Regents of the University Of California, Los Angeles
Project Title: “UCLA Alzheimer’s and dementia care: comprehensive, coordinated, patient-centered”

CMS awarded the first of two grants in Alzheimer’s disease care to UCLA, who will use its $3.2 million award to expand a new program to provide coordinated, comprehensive care to patients and families for Medicare and Medicaid beneficiaries with Alzheimer’s disease or other forms of dementia. Our longtime friend and grantee David Reuben heads the UCLA Division of Geriatrics and our Center of Excellence there. You can view the press release about the launch of the initial program, or watch a video featuring Dr. Reuben:

4. Trustees of Indiana University
Project Title: “CommunityRx System: Dissemination of the aging brain core program”

The other project funded in Alzheimer’s disease care, this $7.8 million grant is based on work from our Indiana University Center of Excellence in Geriatric Medicine. It involves dissemination of the Aging Brain Care model, which provides individualized and integrated care through a multidisciplinary team to dementia patients and their caregivers. It was developed at the Aging Brain Center, headed by Malaz Boustani, a Beeson scholar. One of his Beeson colleagues, Chris Callahan, also a professor in aging research at Indiana University and the founder of the university’s Center for Aging Research, also contributed to the model. Here’s the press release.

5. Beth Israel Deaconess
Project Title: “Preventing avoidable re-hospitalizations: Post-Acute Care Transition Program (PACT)”

Beth Israel Deaconess Medical Center of Boston, Massachusetts, is receiving a $4.9 million award to improve care and reduce hospital readmissions for Medicare and dually eligible patients by integrating care, improving patients’ transitions between locations of care, and focusing on evidence-based best practices. We are proud of our Center of Excellence there, headed by Lew Lipsitz, as well as grantee Randi Berkowitz, whose work on reducing rehospitalizations from geriatric skilled nursing units informed the project. Here is the Beth Israel Deaconess press release.

6. Mount Sinai School of Medicine
Project Title: "Geriatric emergency department innovations in care through workforce, informatics, and structural enhancements (GEDI WISE)"

Mt. Sinai School of Medicine, one of our Centers of Excellence and a hotbed of geriatrics for specialists, is receiving a $12.7 million award to integrate geriatric care with emergency department (ED) care in three large, urban acute care hospitals in New York, New Jersey, and Illinois. Designing specialized emergency rooms to improve outcomes for older patients is beginning to catch on, and we are proud that the groundbreaking work of Jahnigen Scholar and Mt. Sinai professor Ula Hwang on geriatric emergency medicine has gotten so much recognition and support.

7. Johns Hopkins School of Nursing
Project Title: “CAPABLE for frail dually eligible older adults: achieving the triple aim by improving functional ability at home”

This $4 million project is based on the work of grantee Sara Szanton, Hartford Pre-Doctoral and Post-Doctoral Nursing Scholar and developer of a unique home-focused model that includes health care and remodeling services. Called CAPABLE (Community Aging in Place, Advancing Better Living for Elders), the program uses a care management team to improve the everyday functioning of complex, frail patients in their own homes. We featured Dr. Szanton in our annual report last year and blogged about her as well.

8. The Methodist Hospital Research Institute
Project Title: “Delirium detection and prevention across the continuum”

The Methodist Hospital Research Institute and Methodist Hospital System, in partnership with the Baylor College of Medicine, is receiving an $11.7 million award to improve care for Medicare and Medicaid beneficiaries at risk for delirium and associated complications. Our grantees at the Baylor College of Medicine Center of Excellence in Geriatrics, headed by George E. Taffet, were the driving force behind the delirium intervention Methodist Hospital will be testing in the Houston metropolitan area.

We look forward to learning from these projects--from both their results and the process of change they are undertaking. We hope that careful implementation of these proposals, thoughtful and timely evaluation of their results, and the creation of a supportive environment by CMS staff will create an opportunity for models that improve outcomes and reduce wasteful spending to be quickly and widely replicated across the country. We will be following up with winners working on aging and health issues and exploring the potential benefits of a Foundation role, beyond cheerleader-in-chief. Go Team!