7.5 What could other stakeholders do to help a demonstration of MediCaring Communities to succeed?

Many parties could take a variety of actions to help the first MediCaring Communities to succeed. Here is a preliminary list with the entity that could take action and the action desired:

• CMS could provide startup funding through their Center for Medicare and Medicaid Innovation.
• CMS could waive a set of regulations that are well-known to make it unduly complicated to manage a population living with serious illnesses: waive the 3-day hospitalization requirement for eligibility for skilled nursing facility care; waive the requirement to be homebound in order to have home care services; and allow nurse practitioners (where allowed by state law) to authorize any level of care that a physician now must authorize, including generating care plans.
• The Agency for Healthcare Research and Quality (AHRQ), or CMS could fund the development of suitable quality measures and could assure that CMS or a contractor would take on the responsibilities of stewardship for the resulting measures.
• AHRQ or CMS could fund a professional group (like the American Geriatrics Society) to develop evidence-informed clinical standards for this population.
• CMS could provide much of the ongoing data needed for management as part of a plan for evaluating the performance and estimating the savings.
• CMS could work with consumer representative groups to ensure that beneficiaries have adequate protection for their well-being and the privacy of their records.
• CMS, AHRQ, and the Centers for Disease Control and Prevention (CDC) could fund development of a set of population-based measures, including management tools based on the community dashboard and the aggregation of community care plans, that would inform the Community Board as to priorities and progress.
• The Patient-Centered Outcomes Research Institute (PCORI) or another party could take steps to ensure that elderly persons and their surrogates have good information about their choices.
• CMS, ACL, CDC, or AHRQ could contract to develop materials to enable community members to serve effectively on the Community Boards (as CDC has done for tobacco control).
• The state Medicaid programs should collaborate to discern the effects upon their beneficiaries and budgets.
• Cities, counties, and states could set up conditions that make it easier to move toward efficient services when they need to be delivered to homes by enabling geographic concentration of providers.