CMMI’s Savings Record Sparks Concern Among Lawmakers

Members of Congress are questioning the CMS Innovation Center’s progress in moving the nation’s health system to value-based care after a report found the center has increased federal spending instead of lowering it.

The Center for Medicare and Medicaid Innovation, or CMMI, was created by the Affordable Care Act more than a decade ago. The center is tasked with testing new healthcare payment and delivery models to lower costs and improve quality in government health programs.

However, during at House Energy and Commerce subcommittee hearing on Thursday, some lawmakers — particularly Republicans — stressed that CMMI has failed to save money during its first 10 years, and could continue to increase spending over the next decade. 

A Congressional Budget Office report published in September found CMMI’s activities increased direct spending by $5.4 billion between 2011 and 2020. The center is projected to bump net federal spending by $1.3 billion from 2021 to 2030, according to the analysis.

“I have a hard time believing any objective observer could look at the results thus far and describe CMMI as a success,” said Rep. Cathy McMorris Rodgers, R-Wash.

Few CMMI models have been expanded

CMMI has implemented more than 50 model tests, which affected over 41 million patients and more than 314,000 providers, testified Elizabeth Fowler, deputy administrator and director of CMMI, during the Health subcommittee hearing.

However, only six models have generated statistically significant savings, and just four were certified for expansion, according to the CBO’s report.

One challenge to achieving cost savings is that the models are voluntary, said Fowler, who has led CMMI since 2021.

“When you have a voluntary model where providers can come in if they think the terms look favorable, if they can exit if they think the terms may turn against them or they weren’t performing as well as they thought, they can drop out of the model,” she said. 

And some models — like the Medicare Care Choices Model, which aimed to increase access to supportive care from hospice providers — aren’t expanded, even if they show cost and quality improvements, said Rep. Kim Schrier, D-Wash. 

“I’m concerned about CMMI’s current standards for program expansion, and whether they might be too rigid and even prohibitive,” Schrier said.

The Medicare Care Choices Model did reduce net Medicare spending, while cutting down inpatient admissions and outpatient emergency visits, Fowler said. However, it didn’t meet the standard for generalizability across the patient population.

Still, Fowler said the innovation center learns from every model, even if they aren’t eventually expanded. And those lessons are incorporated into future models, she said.

“We think that our models have all been successful in one sense or the other, that we’re learning something, regardless of the ultimate assessment,” Fowler said.

Strategic refresh aims to inject transparency

Some legislators raised concerns about a lack of provider input into CMMI models. But a new strategic direction for CMMI, announced in 2021, should improve transparency and lay out the center’s priorities, Fowler said.

“Many stakeholders, including healthcare providers and various industry stakeholders, have expressed concern about the complexity, administrative burden and perceived lack of transparency involved when participating in the CMMI models,” said Rep. Bob Latta, R-Ohio.

The agency is in contact with providers, and asks them what didn’t work when they choose to exit models, Fowler said. The refresh includes five objectives, like honing in on health equity and enrolling significantly more Medicaid and Medicare beneficiaries in accountable care arrangements.

“I think we’re really trying to be more transparent in the way that we conduct our business. Trying to signal where we’re going next is the point of the strategy refresh that we put out in 2021,” Fowler said. “And really just generally trying to be good partners for the providers who are out there and make sure that we’re reflecting their input in our work going forward.”