Warning: Significant Changes at CMS Innovation Center

On March 12,

The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced significant changes to its model portfolio to better align with its “statutory obligations and strategic goals,” noting that it will “protect taxpayers and enhance the health of Americans by focusing on models that demonstrate cost savings and improved quality of care.”

This initiative involves the early termination of underperforming models, modifications to existing models, and the discontinuation of planned initiatives. CMS reported that these changes will result in taxpayer savings of nearly $750 million; however, the math seems a little unclear.

The CMS Innovation Center was established under the Patient Protection and Affordable Care Act to develop and test innovative payment and service delivery models. These models aim to reduce expenditures within Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) while ensuring high-quality care.

However, after a recent assessment, CMS determined that some models were not delivering sufficient cost savings or quality improvements. As a result, the agency has decided to conclude certain models by the end of 2025 and modify others to align with its long-term objectives.

As part of the realignment, CMS will terminate the following models ahead of their original end dates:

• Maryland Total Cost of Care (2019–2026): This program will move over to the AHEAD program, so while listed as a termination and cost savings, this really looks like a change in title and official move to the AHEAD program, which already lists Maryland as part of Cohort 1.
• Primary Care First (2021–2026): Focused on enhancing primary care services to improve patient care and reduce Medicare expenditures.
• End-Stage Renal Disease (ESRD) Treatment Choices (2021–2027): Encouraged increased use of home dialysis and kidney transplants for ESRD patients; CMS will propose its termination through rulemaking, so more to come on if this will be discontinued, but it is officially on alert.
• Making Care Primary (2024–2034): Intended to strengthen primary care services and build upon previous initiatives, but will end prematurely. This program focused on incorporating health-related social needs into primary care infrastructure for risk stratification.

CMS also mentioned that it is evaluating potential adjustments to the Integrated Care for Kids (2020–2026) model, which may include reducing the scope of awards or implementing structural changes to better align with strategic goals. This model operates in seven states and is an integrated approach for physical and behavioral health services.

The announcement also cited that CMS will no longer move forward with the following initiatives:

• Medicare $2 Drug List: This initiative aimed to provide certain generic drugs to Medicare beneficiaries at a $2 price point.
• Accelerating Clinical Evidence: Designed to incentivize drug manufacturers to complete confirmatory trials for drugs receiving accelerated approval.

The limited briefing did state that CMS will provide guidance and technical assistance to affected participants to ensure a smooth transition and continuity of care for beneficiaries.

Although new programs have yet to be offered, CMS stated that they are shifting their strategy to emphasize preventive care, patient empowerment, and competition within the healthcare system.

Programming note: Listen live today for the social determinants of health (SDoH) report with senior healthcare consultant Tiffany Ferguson on Talk Ten Tuesday with Chuck Buck and Angela Comfort at 10 Eastern.