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Established under the Affordable Care Act, the Center for Medicare and Medicaid Innovation (CMMI) has continually evolved its approach to developing and testing innovations in healthcare payment and service delivery. Across multiple administrations, CMMI has worked to advance its three-pronged mission to lower costs, improve patient care, and align payment to promote patient centered practices.
Given ongoing stakeholder scrutiny as well as the Congressional Budget Office’s (CBO’s) 2023 fiscal assessment of CMMI’s impact and effectiveness, the Healthcare Leadership Council (HLC) commissioned Avalere Health to conduct a broader analysis of CMMI reflective of its expansive mission statement. To conduct this more complete assessment, Avalere Health evaluated 18 CMMI models by examining three components:

1. Impacts on federal expenditures
2. Effects on quality of care, and
3. Level of transparency available during model design and implementation.

In comparison to previous analyses, Avalere Health considered newer quality metrics for outcomes based on patient demographics (included since the agency’s 2021 Strategic Refresh), along with an assessment of transparency and opportunities for feedback.
In analyzing 18 CMMI models across these three categories, Avalere Health found the following:

• Net costs, which include the costs to implement and evaluate each model, aligned with the CBO’s findings: CMMI models, in aggregate, are not generating direct savings to Medicare. However, select models were effective at reducing net costs and offer specific positive indications for CMMI’s ability to generate savings in future models. Of the 18 models analyzed:
  • One-third of the models yielded substantial net savings for the federal government
  • One-third of the models generated substantial net losses
  • One-third of the models had nominal financial impacts as of their latest evaluation report
• There were measurable improvements in quality measures across several CMMI models, although there was little-to-no impact reflected in patient experience surveys and, where available, there were mixed results in outcomes across patient demographics. Of the 18 models analyzed:
  • Four showed quality performance improvement
  • Three showed nominal quality performance improvement
  • Four had no statistically significant impact on quality performance
  • Seven showed mixed results on quality performance
• There were limited opportunities for public input during the design stage of these models. There were also mixed results in the extent of publicly available financial and quality data during a model’s performance period. Of the 18 models analyzed:
  • Nine solicited comments on model development or refinement via rulemaking or Requests for Information
  • No models in the analysis were endorsed by the Physician-Focused Payment Model Technical Advisory Committee

Read the full whitepaper here. 

Funding for this research was provided by the Healthcare Leadership Council. Avalere Health retained full editorial control.