The Center for Medicare and Medicaid Innovation – A Decade of Experimentation and Continued Evolution

Abstract

Over the last decade, the Center for Medicare and Medicaid Innovation (CMMI or the “Innovation Center”) has lived up to its charge from the Affordable Care Act (ACA) to “test innovative payment and services delivery models.” [1] CMMI was appropriated $10 billion of mandatory funding during 2010–2019, which will continue unless Congress amends the law, and these resources have been used to launch numerous models that are increasing in scope and reach. In 2016–2018 alone, CMMI announced or tested 36 models [2]. In 2019, major new initiatives were announced that stretch across the care continuum with direct contracting (DC) models that build on accountable care organizations (ACOs), primary care first (PCF) models, radiation oncology bundles, end-stage renal disease (ESRD) models, and even a low-acuity ambulance triage model. CMMI’s work has spanned Democratic and Republican administrations and Congresses, signaling bipartisan support for the entity and its mission.

The most telling data to illustrate the reach of CMMI’s experimentation are the numbers of providers and patients participating in or receiving care through its initiatives. The Centers for Medicare and Medicaid Services (CMS) estimates that 26.7 million Medicare and Medicaid beneficiaries and patients with commercial insurance are or will be receiving care through a CMMI initiative [2]. These numbers are only expected to grow with CMS projecting that 25% of all Medicare fee-for-service (FFS) beneficiaries – or 11 million individuals – could receive care through the new primary care initiatives alone [3]. Providers are also participating in CMMI initiatives in large numbers, with CMS estimating 967,800 in new payment and delivery models [2]. Last, CMMI initiatives target nearly all parts of the healthcare continuum, as well as payers underscoring how the experimentation is extending into all parts of the healthcare system.