Innovation center stage.

One lesser known element of the Patient Protection and Affordable Care Act was the establishment in 2011 of the Center for Medicare and Medicaid Innovation (CMMI), a federal program administered by the US Department of Health and Human Services. With a $10 billion funding commitment over its first decade of operation, the goal of CMMI is to test innovative payment and service delivery models to reduce expenditures while preserving or enhancing quality of care. The authors of the legislation sought nothing short of a transformation of American health care [1]. By 2014, 146 proposals had been funded, with budgets ranging from $1 million to $76 million, each 3 years in duration. Not surprisingly, big-picture issues—accountable care organizations, patient-centered medical homes, bundled payments, and primary care redesign—dominate the portfolio of CMMI activities [2,3]. Among the more inventive trials in these categories are remote patient monitoring includingweb-based tools, e-consulting to expand specialty care in rural hospitals, care management in complex combinations of chronic diseases, and an expanded primary care role for practitioners such as pharmacists.Other examples include intensive outpatient care (hospital in home), primary care for children centered at their schools, and concentrated shared decision making surrounding back surgery. What about diagnostic imaging awards? Might not the imagingoriented trials provide a glimpse into Medicare officials’ ideas about opportunities for improvement and potential solutions? Thefirst of these is based inDetroit, where an urban medical center and a large physician group will establish