CMS Innovation Center Ending Several Payment Models Early
The CMS Innovation Center has announced it will end several alternative payment model programs at the end of 2025, including the Primary Care First and Making Care Primary models as well as the End Stage Renal Disease Treatment Choices model.
The Innovation Center statement said the early termination of Primary Care First and Making Care Primary does not signal a retreat from its support of primary care providers, but rather “a need to focus on different approaches that are consistent with the CMS Innovation Center’s statutory mandate and produce savings.”
Most models selected for early termination are within two years of their end date. Also ending early is the Maryland Total Cost of Care model, which was planned to run through 2026.
Primary Care First was scheduled to run through 2026, and Making Care Primary was scheduled through 2034.
ESRD Treatment Choices was supposed to end in 2027. The Innovation Center said it would propose terminating it through rulemaking.
CMS is considering options to reduce the size of the Integrated Care for Kids (2020 – 2026) awards or make other changes to the model.
Further, the CMS Innovation Center will no longer pursue two previously announced but not yet implemented models:
• Medicare $2 Drug List
• Accelerating Clinical Evidence
The CMS Innovation Center said it has determined its other active models can meet the Center’s statutory mandate—either as is or with future modification—and therefore will continue moving forward.
At a congressional hearing last June, Elizabeth Fowler, Ph.D., J.D., director of the Innovation Center, was pressed to explain why so few of its alternative payment models have produced cost savings.
In a meeting of the Health Subcommittee of the the U.S. House Energy and Commerce Committee, Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, began by outlining her concerns.
The Innovation Center, also known as the Center for Medicare & Medicaid Innovation (CMMI) was created to help improve how Medicare and Medicaid pay for healthcare and to be an engine in our drive towards value-based care, Rogers said. “CMMI was given a 10-year, $10 billion budget and extremely wide-ranging authorities with limited built-in congressional oversight. The only directives Congress gave CMMI were to achieve two goals: lowering the cost of delivering care and improved patient outcomes.”
Over the last decade and a half, CMMI has tested over 50 models to accomplish both those goals. When CMMI was created, the savings it was projected to generate were to be used to offset spending by the Affordable Care Act, Rogers continued. Originally, CBO estimated that CMMI would save $1.3 billion over its first decade of operation. That same model also projected CMMI would save as much as $77.5 billion in its second decade from 2020 to 2023. “However, when CBO looked at the actual results in a September 2023 report, the disparity between those expectations and the reality proved to be staggering. Instead of reducing spending by $1.3 billion in the first decade, CMMI increased spending by $5.4 billion. For the second decade, instead of saving $77.5 billion, CBO is now projecting CMMI to increase spending by $1.3 billion. I have a hard time believing any objective observer could look at the results thus far and describe CMMI as a success. So how do we move forward?”
The CMS statement said that by ending these models early, it will save taxpayers $750 million.
The Innovation Center now says it plans to announce a new strategy based on guiding principles to make Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition. This announcement streamlines the focus of CMMI’s models and will help build a health system that improves quality and lowers costs while helping Americans live healthier lives, the statement said.
