GAO: Just 4 of 37 CMMI Payment Models Have Met Goals around Cost, Quality | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

GAO: Just 4 of 37 CMMI Payment Models Have Met Goals around Cost, Quality

May 11, 2018
by Rajiv Leventhal
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The Center for Medicare and Medicaid Innovation (CMMI), created to test new and cost-effective approaches for delivering and paying for healthcare, has partially met its goals, while just four out of the innovation center’s 37 alternative payment models have actually achieved lower spending and higher quality, according to a recent Government Accountability Office (GAO) report.

The Affordable Care Act created the CMS (Centers for Medicare & Medicaid Services) Innovation Center eight years ago to test new approaches to healthcare delivery, known as models, that could curb spending while providing better care. As of March 2018, CMMI had implemented 37 such alternative payment models, which are varied based on several characteristics, including the program covered—Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or some combination of the three—and the nature of provider participation—voluntary or mandatory. Through fiscal year 2016, the Innovation Center obligated $5.6 billion of its $10 billion appropriation for fiscal years 2011 through 2019.

When CMMI was launched, the federal agency outlined three core goals for its innovation arm: 1) decrease healthcare cost growth while promoting improved health and care quality; 2) identify, test, and improve alternative payment and care delivery models; and 3) accelerate the spread of successful models and best practices. According to GAO’s findings, CMMI has partially met the first and third goals, while fully meeting the second goal.

More specifically, regarding the first goal, decreasing healthcare cost growth while promoting improved health and care quality—inclusive of three performance measures that focus on ACOs (accountable care organizations)—the Innovation Center has reported mixed results in achieving the targets set, GAO reported. According to agency-reported data, the Innovation Center met the targets for two of the three goal 1 performance measures for 2015. For the remaining measure—the percentage of ACOs that shared in savings—the center did not meet its target during either of the two years for which data were available, per the report.

CMS officials stated that the missed target was driven by the high growth in the number of ACOs that were new—and therefore would not yet be expected to achieve a level of savings in which they could share—and not by ACO performance deficits. As a result, officials decided that no adjustments were required to the Medicare Shared Savings Program (MSSP) or other ACO models to help improve performance.

However, the Innovation Center set a target for 2016 that was lower than the 2015 target, GAO found. For 2017, the Innovation Center lowered the expectation for growth compared to previous years, setting a target that was 1-percent higher than the 2016 target. Moving forward, CMS believes that as more ACOs gain experience, more will share in savings, according to the report.

Regarding the second goal, which has one performance measure that identifies the number of models that currently indicate (1) cost savings while maintaining or improving quality or (2) improving quality while maintaining or reducing cost, four models have met this target: the Pioneer ACO, the Diabetes Prevention Program, the Initiative to Prevent Avoidable Hospitalizations among Nursing Facilities Residents Phase 1, and lower-extremity joint replacement under the BPCI.

While these four models have met the second goal, CMMI formally requested that CMS’ Office of the Actuary analyze the financial impact of a potential expansion of just two of those four: the Pioneer ACO and the Diabetes Prevention Program.

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