1. CMMI Update Amy Bassano, Deputy Director,
Center for Medicare and Medicaid Innovation
November 8, 2018

2. The CMS Innovation Center Statute
“The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care furnished to individuals under such titles”
Three scenarios for success from Statute:
Quality improves; cost neutral
Quality neutral; cost reduced
Quality improves; cost reduced (best case)
If a model meets one of these three criteria and other statutory prerequisites, the statute allows the Secretary to expand the duration and scope of a model through rulemaking

3. CMS Innovation Center’s range of impact
Beneficiaries touched
CMS Innovation Center models impact over 18M beneficiaries1,2 in all 50 states
Providers participating
Over 200,000 health care providers and provider groups2 across the nation are participating in CMS Innovation Center programs
> 18 million
> 207,000
1 Includes CMS beneficiaries (i.e., individuals with coverage through Medicare FFS, Medicaid, both Medicare and Medicaid (as Medicare-Medicaid enrollees), CHIP, and Medicare Advantage) and individuals with private insurance, including in multi-payer models
2 Figures as of September 30, 2016
Source: Innovation Center Report to Congress, December 2016

4. The Innovation Center portfolio aligns with broader CMS goals
Test alternative payment models
Pay Providers
Accountable Care
Medicare Diabetes Prevention Program Expanded Model
ACO Investment Model
Bundled payment models
Pioneer ACO Model
Bundled Payment for Care Improvement Models 1-4
Medicare Shared Savings Program (housed in Center for Medicare)
BPCI Advanced
Oncology Care Model
Comprehensive ESRD Care Initiative
Comprehensive Care for Joint Replacement
Next Generation ACO
Initiatives Focused on the Medicaid Population
Medicaid Incentives for Prevention of Chronic Diseases
Primary Care Transformation
Strong Start Initiative
Comprehensive Primary Care Initiative (CPC) & CPC+
Medicaid Innovation Accelerator Program
Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration
Dual Eligible (Medicare-Medicaid Enrollees)
Financial Alignment Initiative
Independence at Home Demonstration
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents
Graduate Nurse Education Demonstration
Home Health Value Based Purchasing
Medicare Advantage (Part C) and Part D
Medicare Care Choices
Medicare Advantage Value-Based Insurance Design Model
Frontier Community Health Integration Project
Part D Enhanced Medication Therapy Management
Deliver Care
Support providers and states to improve the delivery of care
Learning and Diffusion
State Innovation Models Initiative
Partnership for Patients
SIM Round 1 & SIM Round 2
Transforming Clinical Practice
Maryland All-Payer Model
Pennsylvania Rural Health Model
Health Care Innovation Awards
Vermont All-Payer ACO Model
Accountable Health Communities
Million Hearts Cardiovascular Risk Reduction Model
Distribute Information
Increase information available for effective informed decision-making by consumers and providers
Information to providers in CMMI models
Shared decision-making required by many models

5. Innovation Center all-inclusive portfolio
ACO Investment Model
Accountable Health Communities Model
Advance Payment ACO Model
Advanced Primary Care Initiatives
Bundled Payments for Care Improvement Models 1-4
Bundled Payments for Care Improvement (BPCI) Advanced
Cardiac Rehabilitation (CR) Incentive Payment Model
Community-based Care Transitions Program
Comprehensive Care for Joint Replacement Model
Comprehensive ESRD Care Model
Comprehensive Primary Care Initiative
Comprehensive Primary Care Plus + Round 2
Financial Alignment Initiative for Medicare-Medicaid Enrollees
FQHC Advanced Primary Care Practice Demonstration
Frontier Community Health Integration Project Demonstration
Graduate Nurse Education Demonstration
Health Care Innovation Awards: Round 1, Round 2
Health Plan Innovation Initiatives
Home Health Value-Based Purchasing Model
Independence at Home Demonstration
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents
Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents: Phase Two
Innovation Advisors Program
Maryland All-Payer Model
Maryland Total Cost of Care Model
Medicaid Emergency Psychiatric Demonstration
Medicaid Incentives for the Prevention of Chronic Diseases Model
Medicaid Innovation Accelerator Program
Medicare Acute Care Episode (ACE) Demonstration
Medicare Advantage Value-Based Insurance Design Model
Medicare Care Choices Model
Medicare Coordinated Care Demonstration
Medicare Diabetes Prevention Program Expanded Model
Medicare Health Care Quality Demonstration
Medicare Hospital Gainsharing Demonstration
Medicare Imaging Demonstration
Medicare Intravenous Immune Globulin (IVIG) Demonstration
Million Hearts
Million Hearts: Cardiovascular Disease Risk Reduction Model
Multi-Payer Advanced Primary Care Practice
Next Generation ACO Model
Nursing Home Value-Based Purchasing Demonstration
Oncology Care Model
Part D Enhanced Medication Therapy Management Model
Partnership for Patients
Pennsylvania Rural Health Model
Physician Group Practice Transition Demonstration
Physician Hospital Collaboration Demonstration
Pioneer ACO Model
Private, For-Profit Demonstration Project for the Program of All-Inclusive Care for the Elderly (PACE)
Regional Budget Payment Concept
Rural Community Hospital Demonstration
Specialty Practitioner Payment Model Opportunities
State Innovation Models Initiatives
Strong Start for Mothers and Newborns Initiatives
Transforming Clinical Practice Initiative
Vermont All-Payer Model

6. New Direction - CMS Innovation Center Request for Information (RFI)
The RFI seeks broad input related to a new direction for the CMS Innovation Center that will promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, and improve outcomes.
The administration plans to launch models in several focus areas:
Guiding Principles
Choice and competition in the marketplace
Provider choice and incentives
Patient-centered care
Benefit design and price transparency
Transparent model design and evaluation
Small scale testing
Expanded Opportunities for Participation in Advanced APMs
Consumer-Directed Care & Market-Based Innovation Models
Physician Specialty Models
Physician-Focused Payment Model Technical Advisory Committee (PTAC) Recommended Models
Prescription Drug Models
Medicare Advantage (MA) Innovation Models
State-Based and Local Innovation, including Medicaid-focused Models
Mental and Behavioral Health Models
Program Integrity

7. Comprehensive Primary Care Plus (CPC+)
CMS’s largest-ever initiative to transform how primary care is delivered and paid for in America
Goals
Participants and Partners
Strengthen primary care through multi-payer payment reform and care delivery transformation.
Support clinicians to provide comprehensive care that meets the needs of all patients.
Improve quality, access, and efficiency of care.
Advanced primary care practices in two rounds:
Round 1: 2,893 practices in 14 regions
Round 2: Up to 1,000 practices in 4 regions
Two tracks to accommodate diversity of practices
62 public and private payers in CPC+ regions
Health IT vendors partner with CMS and Track 2 practices
5 year model: ;
Care Transformation Functions
Payment Redesign Components
PBPM risk-adjusted care management fees
Access and continuity
Performance-based incentive payments for quality, experience, and utilization measures that drive total cost of care
Care management
Comprehensiveness and coordination
For Track 2, hybrid of reduced fee-for-service payments and up-front “Comprehensive Primary Care Payment” to offer flexibility in delivering care outside traditional office visits
Patient and caregiver engagement
Planned care and population health

8. Pennsylvania Rural Health Model aims to help rural hospitals improve quality and address community health needs
Alternative payment model, which began on January 12, 2017, in collaboration with Pennsylvania and focused on improving the cost and quality of care delivered at hospitals in rural Pennsylvania.
Key Features:
Hospital Global Budgets: Pennsylvania will set the all-payer global budget for each participating rural hospital for inpatient and outpatient services
Hospital Care Delivery Transformation: Hospitals will plan changes to redesign care, including investing in quality and tailoring services to their communities
Funding for Model: $25 million made available to help Pennsylvania begin Model implementation
Pennsylvania Commits to Achieving the Following Rural Targets:
Financial: $35 million in Medicare hospital savings; all-payer target of no more than 3.38% in annual hospital spending growth.
Scale: At least 6 rural hospitals will participate during Performance Year 1 (2018), 18 rural hospitals during Performance Year 2 (2019), and 30 rural hospitals during each of Performance Years 3 through 6 ( ).
Population Health, Access & Quality: 1) increase access to primary and specialty care; 2) reduce rural health disparities through improved chronic disease management; and 3) decrease deaths from substance use.

9. Maryland Total Cost of Care Model
New Model in Maryland Covering Full Continuum of Care
Components of Maryland Total Cost of Care Model
Hospital Global Budgets
Population-based payments for Maryland hospitals; Continuation of policy from Maryland All-Payer Model
Care Redesign Program
Gainsharing between hospitals, hospital-based specialists, non-hospital providers
Maryland Comprehensive Primary Care Program
Financial support for primary care providers performing care management for high-risk patients
Hospital only
Inpatient and outpatient settings
Primary care and community settings
Benefits of TCOC Model
Adds new providers and settings into care transformation effort
Links disparate providers to create more patient- centered care
Aligns incentives across providers to reduce hospitalizations and total cost of care
Performance Period begins January 1, 2019 and continues through 2026

10. Bundled Payment for Care Improvement Advanced (BPCI Advanced)
BPCI Advanced is a voluntary bundled payment model that qualifies as an Advanced Alternative Payment Model (Advanced APM) with payment tied to performance on quality measures.
Runs October 1, 2018 through December 31, 2023
Single payment and risk track, with a 90-day episode period
29 Inpatient Clinical Episodes
3 Outpatient Clinical Episodes
Preliminary Target Prices provided prior to the start of the Performance Period
Who can participate?
Convener Participants (Medicare enrolled or non-Medicare enrolled providers)
Non-Convener Participants (Medicare enrolled providers only)
Who are the Episode Initiators?
Acute Care Hospitals (ACHs)
Physician Group Practices (PGPs)

11. Key Differences: BPCI vs. BPCI Advanced
48 Inpatient (IP) Clinical Episodes
29 IP and 3 OP Clinical Episodes
Not an Advanced APM since lacking CEHRT requirement and quality not tied to payment
Model is an Advanced APM
No quality measures required for payment purposes
Quality measures are reportable and performance on these measures will be tied to payment
Excludes cost of care associated with services according to 13 unique exclusion listings of “unrelated” care
Limited exclusions; Excludes the Part A & B costs associated with ACH readmissions qualifying based on a limited set of MS-DRGs
Model 3 includes PAC providers triggering episodes in the post-discharge period
No equivalent for Model 3; design is similar to Model 2 with PGPs and ACHs as EIs; PAC Providers, and other Medicare-enrolled, as well as non-Medicare-enrolled entities can participate as Convener Participants
Risk corridor of 20% of spending above the upper limit of the selected risk track
One risk track
Risk is capped at +/-20%
Target Prices provided at reconciliation
Preliminary Target Prices provided prospectively, before the start of each Model Year

12. Accountable Health Communities Model addresses health-related social needs
Key Innovations
Systematic screening of all Medicare and Medicaid beneficiaries to identify unmet health-related social needs
Tests the effectiveness of referrals and community services navigation on total cost of care using a rigorous mixed method evaluative approach
Partner alignment at the community level and implementation of a community- wide quality improvement approach to address beneficiary needs
Model Tracks
Assistance Track
Bridge Organizations in this track provide community service navigation services to assist high-risk beneficiaries with accessing services to address health-related social needs
Alignment Track
Bridge Organizations in this track encourage partner alignment to ensure that community services are available and responsive to the needs of beneficiaries

13. Integrated Care for Kids (InCK) Model
The InCK Model is a child-centered local service delivery and state payment model aimed at reducing expenditures and improving the quality of care for children covered by Medicaid and CHIP, especially those with or at-risk for developing significant health needs.
Goals:
Improving performance on priority measures of child health 1
Reducing avoidable inpatient stays and out-of-home placements 2
Creation of sustainable Alternative Payment Models (APMs) 3
Up to 8 cooperative agreement awards anticipated Summer 2019

14. Medicare Diabetes Prevention Program (DPP) Expanded Model
MDPP is a structured behavioral intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes.
Timeline:
2012 – CMS Innovation Center awarded Health Care Innovation Award to The Young Men’s Christian Association of the USA (YMCA) to test the DPP in >7,000 Medicare beneficiaries with pre-diabetes across 17 sites nationwide.
2016 – DPP announced as the first ever prevention model to meet statutory criteria for expansion. The Secretary determined that DPP:
Improves quality of care beneficiaries lost about five percent body weight
Certified by the Office of the Actuary as cost-saving projected net savings of $186 Million to the Medicare Program over a 10 year period
Does not alter the coverage or provision of benefits
– National expansion established through rulemaking, with policies to create a new supplier class finalized in CY 2017 PFS Final Rule and additional policies related to performance-based payment proposed in CY 2018 PFS Proposed Rule.
April 2018 – National availability of MDPP set of services to Medicare beneficiaries.

15. Innovation Center – 2018 Looking Forward
We are focused on:
Implementation of Models
Monitoring & Optimization of Results
Evaluation and Scaling
Integrating Innovation across CMS
Portfolio analysis and launch new models to round out portfolio

16. Thank you! Questions?