5: Partnerships
Collaborative Partnerships Other Information:
CMS recognizes that its success is dependent on collaborative relationships with a variety of organizations, individuals,
and institutions, such as the U.S. Congress, states, physicians, hospitals, other provider types, professional societies,
health plans, employers, State Health Insurance Assistance Programs (SHIPs), community grassroots, and other organizations,
building upon our recent collaborative experiences and partnerships in successfully implementing Medicare Part D. A partnership
with CMS consists of organizations coming together around issues that affect a common population. By working together, partners
extend the reach and impact of programs aimed to improve the health and wellness of seniors, children, families, and people
with disabilities, and indirectly impact caregivers and employers. A partnership with CMS allows the partners to leverage
their resources and expertise, and to share access to CMS’ training and educational materials, research, and a connection
to the Regional Offices. The CMS definition of partnership is expanded to allow for meaningful two-way exchange and true collaboration
for all CMS programs and special initiatives. Internal Customer Service To ensure success with external partnerships, CMS
must recognize that the practice of partnership begins internally, starting with mutually-supportive working relationships
between all components. CMS employees must make a conscious effort to support one another in our work, incorporating cross-component
communication and integration. To support this, CMS will: • Integrate the CMS Office of External Affairs into a primary role
with respect to the program goals, ensuring appropriate roles for partnership, media, and intergovernmental affairs; • Develop
cross-component work teams as appropriate; • Continue Regional Offices’ role as “on-the-ground” resources in planning and
implementing agency outreach initiatives; and • Continue the commitment to provide training for relationship management and
work teams. External Partners To achieve real improvements in quality, we need to work together in partnership with other
stakeholders from throughout our health care system. We have opportunities for system-wide quality improvement today because
of the broad interest, commitment, and momentum to create and sustain a better environment for high-quality, personalized
care for every patient every time. This is not a CMS-led effort – it comes from all parts of our health care system. Our system
has the advantages of flexibility and responsiveness to new ideas and to individual patient needs. We aren’t as constrained
by “one-size-fits-all” rules that are increasingly bad fits in modern health care. This is important, with all the promising
new approaches for delivering health care. But the pluralism of our system also means no one entity can close the quality
gap by itself. And because CMS is such an important part of the health care system, the agency must participate actively as
full partners in these collaborative efforts. Our external partnerships include both new or enhanced collaborations with other
government agencies and unprecedented collaborations with many health advocacy, research, and provider organizations. Our
government partners include agencies such as the Administration on Aging (AoA), Health Resources & Services Administration
(HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Healthcare Research and Quality (AHRQ),
National Institutes of Health (NIH), U.S. Department of Agriculture (USDA), Centers for Disease Control and Prevention (CDC),
Food and Drug Administration (FDA), the Veterans Administration (VA), Social Security Administration (SSA), Railroad Retirement
Board (RRB), Office of Personnel Management (OPM), and the Department of Defense (DoD). To move the quality agenda forward,
we are also engaging in numerous partnerships with non-governmental organizations where specific opportunities for short-term
improvements in quality exist. Examples of the central role of strong partnerships in the CMS Quality Roadmap include: • Partnering
with public- and private-sector groups in the Institute for Health Care; • Partnering with the Institute for Healthcare Improvement’s
(IHI) “Campaign to Save 100,000 Lives”, involving dozens of partners and about 2000 enrolled hospitals focused on reducing
the hospital mortality rate; • Partnering with the Surgical Care Improvement Partnership, a public-private group led by the
American College of Surgeons that is working together to reduce surgical complications; • Partnering with the Fistula First
National Renal Coalition, in which a dozen partners are promoting the best evidence-based approach to vascular access for
hemodialysis patients; • Partnering with the Alliance for Cardiac Care Excellence alongside more than 30 organizations supporting
four specific, major improvements in cardiac care; • Partnering with the quality alliances, including the Hospital Quality
Alliance (HQA), Ambulatory Quality Alliance (AQA), Pharmacy Quality Alliance (PQA), and National Quality Forum (NQF) to implement
performance measures; • Partnering with medical societies, like the American Medical Association (AMA) and medical specialty
societies, to support quality initiatives; • Partnering with the National Initiative for Children’s Healthcare Quality to
improve the outcomes of low-birth weight infants; • Partnering with the Centers for Health Care Strategies on Medicaid quality
improvement initiatives related to the business case for quality, disparities and value based purchasing; • Partnering with
the Institute for Quality Laboratory Management (IQLM); and • Participating in the Department’s efforts for interoperability
of IT systems, which include collaboration with America’s Health Information Community (AHIC), the Health Information Technology
Standards Panel (HITSP), the Federal Health Architecture (FHA), Consolidated Health Informatics (CHI), and others. We are
also engaging in focused “breakthrough” projects to achieve large improvements in specific areas where large quality gaps
have been demonstrated and stakeholders have identified specific steps to improve performance. For example, to substantially
increase influenza immunization in nursing homes requires not only participation of and coordination across CMS components
and the Long-term Care Task Force (to develop policy, improve payment, track participation, provide education, share quality
information, and provide technical assistance), but also coordinating with nursing homes, vaccine providers, states, and others.
In addition, we aim to establish collaborative partnerships with other insurers in the U.S. health care system. Our beneficiaries’
health and health behaviors are affected by a lifetime of experience well before they enter our programs. Working with employers
and other social insurance organizations to exchange and implement ideas on how to provide a sustained and coordinated focus
on quality benefits the whole U.S. population – not just our individual programs. In continuing these initiatives, and developing
others, CMS will implement proven partnership techniques, such as: • Using a collaborative approach, CMS will continue to
develop health and grassroots networks for Medicare and Medicaid through an integrated cross-component effort within CMS and
HHS; • Targeting key partners and stakeholders early in the development process of new initiatives to build buy-in and support,
to capture the maximum input from partners, and to use nontraditional partners to “get our message out” timely and consistently;
• Managing partner relationships on a regular, ongoing basis through visits, phone calls, and emails, employing two-way communication
techniques; • Continuing the Regional Offices’ role as primary resources in planning and implementing agency outreach initiatives,
and for working collaboratively with local and grassroots partners and coalitions to develop effective campaigns for informing,
educating, and assisting beneficiaries with health care options; • Maintaining and enhancing relationships with State and
local professional societies and providers, as well as with the National societies and associations; • Expanding our communication
activities to allow us to have well established interactions with outside groups; • Establishing ties with quality alliances
and local communities to support getting better health care; and • Expanding our collaborative relationships with additional
organizations in health care technology, SMART health care, prevention, and health transparency to support the transformation
of health care. Health Plans and Prescription Drug Plan Sponsors To continuously improve beneficiary choices and awareness
of Medicare managed care products and prescription drug coverage we will work with our private sector health plan and prescription
drug plan partners, various industry and trade groups and beneficiary organizations. We will work in collaboration with our
private sector counterparts to design, develop and deliver integrated, high quality health care and prescription drug products
that meet the needs of our customers, the Medicare beneficiaries, and meet the demands of the competitive marketplace. We
will work with beneficiary groups to understand their perspectives on our products. To support this CMS will: • Encourage
Medicare Advantage plans and Part D sponsors to identify approaches to achieving high quality, cost effective health care;
• Identify policy opportunities that encourage the offering of health plans and prescription drug plans that combine effective
care management techniques and prescription drug coverage for the beneficiary; • Work with plan organizations and Part D sponsors,
and industry groups to identify product designs that meet the needs of the beneficiaries and the marketplace; • Collaborate
with beneficiary and consumer groups to identify product designs that tailor to the needs of Medicare beneficiaries and subgroups;
• Improve information interchange among health plans and prescription drug plans that combine coordination of benefits for
our beneficiaries; • Leverage our partnerships with Medicare Advantage plans, Part D sponsors, and industry groups to expand
our opportunities for delivering innovative health care delivery products to Medicare beneficiaries; and • In coordination
with our partners, develop accurate and understandable performance metrics and quality information to assist beneficiaries
in making informed decisions on their health care and prescription drug coverage needs. Intergovernmental Affairs State and
local partnerships are critical to carrying out the mission of CMS. Our State and local partners communicate information to
our beneficiaries about CMS’ activities and programs and help us carry out agency policies. CMS is more than a liaison to
the states. We will continue to garner partner participation, coordinated by the CMS partnership team. We not only want our
State and local partners to receive our information, but to join us in improving health care for our beneficiaries. We will
continue our partnership development with State and local governments by: • Designing and executing the Agency’s communication
plan, coordinating notification of pending actions with partner groups, and serving as liaison between the states and the
agency to broker relations with the states over pending changes in Medicaid, both MMA and DRA related; • Fostering our relationships
with the Governors, State legislators, and increasing our interactions with State and local elected officials, as well as
the many State and local government associations such as the National Governors Associations, Council of State Governments,
National Association of State Medicaid Directors, and the National Council of State Legislators; and • Continuing to develop
these partnerships at the local level and expanding the outreach to include a more comprehensive group of State and local
partners by including county governments, State health insurance commissioners, State and local intergovernmental groups,
and community health centers operated by local governments. Legislative/Congressional Affairs CMS works with the U.S. Congress
to promote beneficiary interests by effectively presenting the Agency’s position to Congress and by making the Agency aware
of congressional positions on issues relevant to the Agency. In addition, we advance the Administration’s policy goals and
objectives by: • Communicating CMS positions to Congress clearly and effectively; • Communicating Congress’ position to CMS;
• Providing prompt and meaningful responses to congressional inquiries; • Providing accurate and informed technical assistance
during the development of legislation; and • Collaborating with other CMS components and administration partners to advance
departmental legislative priorities. State Health Insurance Assistance Program (SHIPs) The State Health Insurance Assistance
Program, or SHIP, is a state-administered CMS grant program, funded jointly with federal, state, and local community funds,
that offers local, personalized counseling and assistance to people with Medicare and their families. States are allowed latitude
in how their programs are structured and services provided. However, programs must offer services to all eligible persons
requesting assistance, develop an intra-State agency referral system, and communicate timely and accurate health insurance
information. The SHIP network is strong, established, and experienced in providing service to the Medicare beneficiaries.
SHIP programs have traditionally provided outreach and training to local organizations that serve beneficiaries; therefore,
they can serve as key partners for strategic planning and implementation at national, state and local levels. CMS will further
integrate the SHIP network into collaborative activities by: • Including representatives of the network in CMS’ strategic
planning processes on both a national and regional level; • Integrating the SHIPs into CMS’ national partners’ strategic planning
processes and the regional and local planning processes early in the process, as part of that collaborative effort; • Setting
mutual expectations of the SHIPs’ and CMS’ roles in state and local planning, and implementing the resulting operational plans;
• Involving SHIPs in planning and assessing the accountability measures for expected outcomes of mutually-implemented operations;
and • Expanding the open door process for the SHIPs to promote feedback to CMS and supply program improvement. Success in
engaging the SHIP Network in CMS’ collaborative planning and implementation processes will result in effective outcomes for
all HHS priorities. • Health Information Technology will be understood and championed by those who provide direct beneficiary
services and community training. • The Medicare Drug Benefit will be promoted and enrollment assistance provided by SHIPs
and their partners. • Medicare Modernization will have benefited by input from a network that on a daily basis deals with
the barriers and issues of the existing systems. • The New Orleans Health System will have local support and input to issues
to be tackled. • The value of preventive benefits to the communities SHIPs serve can be communicated in a manner that will
resonate both with their partners and the beneficiaries they serve. • Rapid response planning for Pandemic Preparedness can
have state and local systems input and readiness for implementation at a local level, in part, through the SHIPs and their
community partners. • Community-level buy–in and understanding of health care for the individual can be achieved by local
collaborations that focus on disease prevalence in their communities. • Effective strategies to reach and serve people with
disabilities in their communities will be implemented.
Objective(s):
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