The Evolving Role of the Center for Medicare and Medicaid Innovation in Achieving Value-Based Payment Goals

Summary

The passage of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMMI) to help advance new payment and delivery models.

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Since its inception, CMMI’s strategy has evolved from voluntary, small models to the inclusion of mandatory models that are much larger in scope. Additionally, other policies have been implemented, further emphasizing the role that CMMI plays in integrating alternative payment models (APMs). In January 2015, the U.S. Department of Health and Human Services announced a goal to shift 50% of Medicare fee-for-service payments to APMs by 2018. Shortly after this announcement, Congress passed the Medicare Access and CHIP Reauthorization Act, which also incentivizes participation in APMs. In the last year of the Obama Administration, CMMI may explore more mandatory models or look to use its authority to expand its smaller models. As CMMI seeks to expand models, how the agency measures and evaluates overall value will be critically important to the future of Medicare payment policy. Similarly, CMMI’s approach to introducing changes to the Medicare and Medicaid programs using its unique regulatory authority rather than a legislative process represents a significant evolution in how HHS is executing its authority, which warrants close attention.

For further details on how CMMI has evolved, read our paper.

Funding for this work was provided by the Pharmaceutical Research and Manufacturers of America.