New research from Avalere finds the Medicare Shared Savings Program (MSSP) and demonstration programs operated by the Center for Medicare & Medicaid Innovation (CMMI) vary in their net impact to the federal budget. Our analysis also shows that aggregate quality performance improved over time for models with multi-year results.

Avalere reviewed the following CMMI demonstration programs with publicly available performance results: (1) Comprehensive Care for Joint Replacement (CJR) model; (2) Comprehensive ESRD Care model; (3) Comprehensive Primary Care (CPC) initiative; (4) Next Generation ACO demonstration; and (5) Pioneer ACO demonstration.  Other large CMMI programs, like the Bundled Payments for Care Improvement Initiative, were considered for the analysis, but do not have publicly-available performance results to support this type of analysis.

Avalere’s review of the performance results of the MSSP and CMMI demonstrations indicate the following:

1. The MSSP has performed substantially below the financial forecasts made by the Congressional Budget Office (CBO);
2. Individual MSSP ACO performance improved as ACOs gained experience with the program;
3. Downside-risk payment models (MSSP Tracks 2 and 3, Pioneer ACO, Next Generation ACO, ESRD Care model) achieved positive aggregate financial results;
4. All ACO programs have produced aggregate program savings compared to benchmark projections;
5. CJR results are limited and do not provide the aggregate financial impact of the program;
6. CPC initiative increased spending; and
7. For models with multi-year results (e.g., MSSP, Pioneer ACO, CPC), aggregate quality performance improved over time.

While our analysis shows that payment demonstrations requiring participants to accept downside risk are reducing Medicare spending, limited data exist for several CMMI demonstrations, making it premature to judge or predict the long-term success of these models.

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Methodology

Avalere analyzed publicly available financial and quality performance results for the MSSP and key CMMI demonstrations. MSSP results are available for 2013–2016. Performance results are available for the entirety of the Pioneer ACO demonstration (2012–2016) and three years of the Comprehensive Primary Care (CPC) initiative (2014–2016). Performance results are only available for one-year, 2016, for the following models: (1) Next Generation ACO; (2) Comprehensive ESRD Care; and (3) Comprehensive Care for Joint Replacement (CJR) model.

Funding for this research was provided by The Pharmaceutical Research and Manufacturers of America (PhRMA). Avalere maintained full editorial control.