Many CMMI models have mixed results

CMMI was created under the Affordable Care Act to test new payment and care delivery models that aim to decrease costs and improve care quality in government healthcare programs. So far, most CMMI models have focused on Medicare.

In the report, Avalere evaluated 18 CMMI models to determine their impact on federal expenditures, effects on quality of care, and level of transparency during their design and implementation.

Overall, CMMI models cost the federal government $7.7 billion, including $6.4 billion in model net expenses and $1.3 billion in model-specific implementation and evaluation costs. Of the 18 models, a third generated savings for the federal government, a third generated substantial losses, and the final third had "nominal financial impacts."

The models that had the greatest savings were the Maryland All-Payer model (approximately $975 million) and the Maryland Total Cost of Care model (approximately $689 million). The models that had the greatest losses were the Medicare Advantage Value-Based Insurance Design model ($4.5 billion+), the Comprehensive Primary Care Plus model ($2.8 billion+), and the Primary Care First model (approximately $847 million).

On quality measures, results were also varied. Four of the 18 models had quality improvements, three had "nominal" improvements, four had no significant impacts on quality, and seven had "mixed results."

Commentary

Recently, CMMI has come under scrutiny for its spending costs. In 2023, an assessment from the Congressional Budget Office found that CMMI increased indirect spending by $5.4 billion between 2011 and 2020, or 0.1% of net Medicare spending during that time.

In March, CMS announced that four CMMI models would be ending at the end of 2025, earlier than originally scheduled. The impacted models were the Primary Care First model, the Making Care Primary model, the ESRD Treatment Choices model, and the Maryland Total Cost of Care model.

"As is the nature of innovation, not every model will work, and the center must be efficient and effective in its response," CMS said. The agency also noted that these changes would help generate almost $750 million in savings, though it did not detail where those savings would come from.

According to Jennifer Skaggs, a manager at Optum Advisory*, post-acute care providers may reconsider their participation in CMMI models going forward due to their mixed financial and quality outcomes. For post-acute care providers interested in joining CMMI models, some key considerations include:

• Financial uncertainty: Participating in these models may include financial risks.
• Quality evaluations: Providers should choose models that align with their strengths in improving patient outcomes.
• Adaptability: Staying informed of any updates or changes is essential.

Separately, the Healthcare Leadership Council, which commissioned the report, said that it hoped the federal government would seek input from the private sector for feedback on refining value-based care strategies.

"While some CMMI models faced challenges, others demonstrated clear success in advancing value-based care," said Maria Ghazal, president and CEO of the Healthcare Leadership Council. "As the Trump Administration guides the Center into a new era, this report provides actionable insights for future program design."

*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.