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:
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:
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.
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