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The Evidence Link: Latest Announcements in Medicare Payment and Delivery System Reform

Keep current with Medicare Payment and Delivery System Reform news, including recently-proposed rules, newly-released spending and quality results, and announcements on model changes.

Go to the Medicare Delivery System Reform: The Evidence Link’s home page.


CMS: Proposed Rule for the Medicare Diabetes Prevention Program (MDPP) Expanded Model (2018)

Nov. 2, 2017 – CMS finalized a set of implementation policies for the MDPP expanded model starting in 2018. The MDPP stems from an earlier Diabetes Prevention Program (DPP) model, which partnered with the YMCA. The DPP model met the statutory criteria for expansion because it achieved Medicare savings of $2,650 for each person enrolled in the model, covered the cost of the program, and improved patient outcomes. Like the DPP, the MDPP focuses on preventing progression of type 2 diabetes in individuals with clinical indication of pre-diabetes and includes a specified “core curriculum” with follow up contact. Participating suppliers are eligible for performance-based payments based on beneficiary weight loss and session attendance. Suppliers will also be able to provide in-kind incentives to beneficiaries to increase patient engagement in healthy behavior change.

CMS Proposed Rule Full Text

CMS Office of the Actuary: Certification Memo for DPP

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CMS/CMMI: Public Use Files for ACOs Posted with 2016 Performance Results

Oct. 27, 2017 – CMS released 2016 performance results for the Medicare Shared Savings Program ACOs, which accompany results for the Next Generation ACO model (first year) and the Pioneer ACO model (fifth and final year) released on October 13, 2017.  Links to download the PUFs for these ACO models are below. For analysis of the performance results, see the Kaiser Family foundation Evidence Link, an interactive resource that synthesizes the most up-to-date evidence on savings and quality for new payment and delivery system reform models in Medicare.

Medicare Shared Savings Program 2016 Results

Next Generation ACO Model 2016 Results (Performance Year 1)

Pioneer ACO Model 2016 Results (Performance Year 5)

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CMS/CMMI: Withdraw of Request for Letters of Intent for Medicare-Medicaid Accountable Care Organization (ACO) Model

Oct. 5, 2017 – CMS announced that it is withdrawing its “Request for Letters of Intent” to states to participate in the CMMI’s Medicare-Medicaid ACO model and does not plan to implement the model at this time. CMS stated that it is not moving forward with this model because, although several states expressed early interest in the model, CMS did not receive any letters of intent for the 2018 start date and received only one letter of intent for 2019.

CMS Announcement

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CMS/CMMI: Innovation Center New Direction Announced: Request for Information (RFI) Seeking Comments on Future Direction

Sep. 20, 2017 – CMS announced that it is seeking stakeholder input and feedback on the future direction of CMMI through an informal Request for Information (RFI). This RFI provides a list of Guiding Principles and introduces eight focus areas for potential models: (1) Increased participation in Advanced Alternative Payment Models (APM); (2) Consumer-Directed Care & Market-Based Innovation Models; (3) Physician Specialty Models; (4) Prescription Drug Models; (5) Medicare Advantage (MA) Innovation Models; (6) State-Based and Local Innovation, including Medicaid-focused Models; (7) Mental and Behavioral Health Models; and (8) Program Integrity. CMS states that comments will be received through November 20, 2017.

“New Direction” Request for Information (RFI) Full Text

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CMS/CMMI: Comprehensive Primary Care (CPC) Initiative Shared Savings and Quality Results (2016)

Sep. 20, 2017 – CMS posted a summary table of 2016 spending and quality results for the CPC medical home model, accounting for 439 participating practices. Results showed that although CPC medical homes had lower spending on Medicare services relative to benchmark levels ($5 million), Medicare payments for care management fees and shared savings incentives were higher, resulting in a net increase in spending of $51 million for the CPC program. CPC practices in two states (Arizona and Oklahoma) received shared saving payments based on their performance. The vast majority of CPC practices (97%) met goals on quality of care.

CPC Initiative 2016 Results (Performance Year 4)

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HHS Office of Inspector General (OIG): “Medicare Shared Savings Program Accountable Care Organizations have Shown Potential for Reducing Savings and Improving Quality”

Aug. 28, 2017 – The HHS OIG released a report that examined the first three years of the Medicare Shared Saving Program (MSSP). The OIG found that two-thirds of all ACOs (282 of 428) reduced spending, relative to their benchmarks, for at least one of the years that they participated in the program. The net reduction in Medicare spending from these ACOs was nearly $1 billion in the first three years, relative to benchmark levels, according to the OIG report. Regarding quality, the OIG study stated that MSSP ACOs outperformed Medicare fee-for-service providers on most (81 percent) of the quality measures. Additionally, a small subset of “high-performing ACOs” reduced spending by an average of $673 per beneficiary for key Medicare services during the review period. In contrast, the national average for fee-for-service providers showed an increase in per beneficiary spending for key Medicare services, according to the OIG study.

HHS OIG Report Full Text

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CMS: Proposed Rule to Cancel Certain Episode Payment Models (EPM) and Cardiac Rehabilitation (CR) Incentive Payment Model and Make Changes to Comprehensive Care for Joint Replacement (CJR) Payment Model

Aug. 17, 2017 – CMS released a proposed rule that would cancel several bundled payment models that were scheduled to start in 2018 and would reduce the number of areas with mandatory participation in a current model. The models proposed for cancellation are part of the “Episode Payment Models” group: the Surgical Hip and Femur Fracture Treatment (SHFFT) model, the Coronary Artery Bypass Graft (CABG) model, and the Acute Myocardial Infarction (AMI) model. CMS also proposed canceling the Cardiac Rehabilitation Incentive Payment model. Each of these models was designed to be mandatory for hospitals in designated geographic areas. For one ongoing model – the Comprehensive Care for Joint Replacement (CJR) model – CMS proposed reducing the number of mandatory geographic areas from 67 to 34. In addition, CMS proposed to make participation voluntary for all low-volume and rural hospital in the remaining mandatory geographic areas. Public comments were due October 16, 2017.

CMS Proposed Rule Full Text

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