The Kaiser Family Foundation recently published a list of frequently asked questions about the Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS).
Also known as the “Innovation Center” CMMI was created by the Affordable Care Act to test new ways to improve care and lower costs within Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Since its inception, CMMI has launched over 40 new payment models, involving more than 18 million patients and 200,000 health care providers.
Much of CMMI’s Medicare-specific payment and delivery system reform work to date has focused on accountable care organizations (ACOs), bundled payment models, and medical homes. Of these, two programs have met the necessary quality improvement and Medicare savings criteria to be eligible for expansion beyond the testing phase—the Diabetes Prevention (DPP) initiative and the Pioneer ACO model.
Most beneficiaries in CMMI models are in Traditional Medicare and may or may not be aware that their doctor is part of a demonstration. The Bipartisan Budget Act of 2018 (BBA) created a process by which beneficiaries wanting to participate in a specific ACO can work with CMS to do so. However, there is currently no similar process allowing a beneficiary to opt out of participation. To effectively avoid having one’s providers be paid under a new model, people with Medicare must seek care from doctors and providers who are not CMMI participants.
While most of CMMI’s Medicare models apply only to Traditional Medicare, the Value-Based Insurance Design (V-BID) model was created for people in Medicare Advantage (MA) plans with specific chronic conditions. CMMI is currently testing the model in 10 states, and plans to expand to 25 states in 2019. In the recently passed BBA, Congress further expanded V-BID to allow participation among MA plans in all states by 2020. In addition, CMS is considering new CMMI models that would include MA plan participation.
Read the FAQs to learn more about these efforts, including the changes CMMI has instituted under the current administration.