The Center for Medicare and Medicaid Innovation (CMMI) introduced and honed models to support value-based care, exploring multiple avenues for lowering costs and refining risk adjustment strategies. 2020 marked the tenth anniversary of the Center for Medicare and Medicaid Innovation (CMMI), and it proved to be a very important year both for the Innovation Center and the broader value-based care movement,” reflected Brad Smith, CMS deputy administration and director of CMMI.
- The Part D Senior Savings model sought to reduce out-of-pocket healthcare spending on insulin. It lowered insulin costs to $35 per month. In 2020, over 1,630 prescription drug plans with 13.2 million enrolees participated in this model.
- The Geographic Direct Contracting model, Direct Contracting Duals model, and Community Health Access and Rural Transformation (CHART) model focused on specific populations in order to achieve better health outcomes.
- CMMI expanded to the national level two models which the center considered successful: the Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport model and the Home Health Value-Based Purchasing model. These programs attempted to solve for unnecessary ambulance utilization and quality of care in home health agencies.
- When CMMI adjusted its Rigorous Data-Tested Benchmarks, it improved several important models that rely upon these benchmarks. Additionally, the center created the Next-Generation Risk Adjustment Methodology to help prevent coding intensity from unduly impacting payments.
- Private payers were far more likely to be involved in riskier models than public payers. As payers surge toward more widespread value-based care, they may wish to mirror CMMI by continuing to revisit benchmarks and risk adjustment methodologies and by honing their targeted solutions.