The CMS Innovation Center https://innovation.cms.gov is testing the Rural Health Model to see whether the predictable nature of global budgets will enable participating rural hospitals to invest in quality and preventive care and tailor their services to better meet the needs of their local communities.
For example, the Pennsylvania Rural Health Model (PARHM) is in place to test whether care delivery transformation in conjunction with hospital global budgets increases rural Pennsylvanians’ access to high quality care. PARHM also needs to reduce the growth of hospital expenditures across payers including Medicare which should improve the financial viability of rural PA hospitals
Pennsylvania acting through their Department of Health is a key partner in jointly administering PARHM with CMS. Participating payers include Medicare, Medicaid, and certain commercial plans. The Model is open to both critical access hospitals and acute care hospitals in rural areas of the state.
Participating rural hospitals in Pennsylvania must prepare Rural Hospital Transformation Plans outlining their proposed care delivery transformation, which must be approved by the State and CMS.
CMS intends to make $25 million available to help the state implement PARHM. Pennsylvania has committed to achieving $35 million in cumulative Medicare hospital savings over the course of the model.
Pennsylvania will use the funding to oversee the model, aggregate and analyze data, compile and submit reports, propose and administer global budgets, approve rural hospital transformation plans, conduct quality assurance, and provide technical assistance to participating rural hospitals as they redesign the care they deliver.
Pennsylvania commits to achieving targets related to population health outcomes and access under PARHM, and may tie the financial incentives for participating rural hospitals to the state’s performance following three goals:
- Increase access to primary and specialty care
- Reduce rural health disparities through improved chronic disease management and preventive screenings
- Decrease deaths from substance use disorder and improve access to treatment for opioid abuse.
The CMS Innovation Center anticipates that PARHM will help CMS design and implement state-driven, all payer payment and care delivery transformation efforts in order to effectively address the challenges faced in rural communities.
Go to https://www.cms.gov/newsroom/fact-sheets/Pennsylvania-rural-health-model for more information on Pennsylvania Rural Health Model.