Medicaid at 50: Time for a Major Overhaul

JAMA: What has the Center for Medicare and Medicaid Innovation (CMMI) accomplished in the past few years? DR BERWICK: [T]he center has really stimulated I think an unprecedented amount of activity around the country in the localities, very local activities, to come up with new ways to give and support care. A great example has been the Partnership for Patients. That was a program that I established when I was administrator, a $1 billion investment in reducing unnecessary readmissions to hospitals and in preventing so-called hospital-acquired conditions. These are injuries in hospital care like bedsores and central-line infections and medication errors. The interim results of the partnership were just reported a couple of months ago, and they’re quite stunning. We have doubledigit improvements—reductions in complications in hospitals, readmission rates the lowest they have been on record, I think... and a lot of progress in the nation on patient safety, and that’s just one contribution of CMMI. It also has fostered experiments with new payment systems like the pioneer accountable care organizations, like the big bundle-payment experiment that is showing some pretty good results, so I think it’s been a very, very wise investment in reinventing care.