CMS Reports on Healthcare Innovation to Congress

Updated: Mar 30


In December 2016, the Centers for Medicare and Medicaid Services (CMS) submitted a report to Congress summarizing the results of the work done through the Center for Medicare and Medicaid Innovation (CMMI).


In this report to Congress, the Center for Medicare and Medicaid Innovation (CMMI, or the CMS Innovation Center) highlighted its various accomplishments over the past six years as it relates to new models of healthcare innovation and delivery. According to Dr. Patrick Conway, Acting Principal Deputy Administrator and Deputy Administrator for Innovation & Quality.


“We have made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care..”


“Before 2010, there had been only modest efforts to improve care and reduce costs. Medicare – the country’s largest health care insurance program – was largely paying for health services based on volume – where providers were paid for every service they ordered or performed – which didn’t necessarily improve the health of beneficiaries or preserve the program for future generations. To improve our health care system, the largest payer of health care stepped up to partner with providers, doctors and other clinicians, states, private payers, consumers, and others to spur innovation. The market and people in communities across the nation have responded this initiative in extraordinary ways and delivered better care to patients.”


Specifically, the report to Congress touted achievements of the department including:

  • Over 30 new payment models launched over the past six years

  • Investments in electronic medical records and a data and analytics infrastructure which are sparking a new set of innovative companies.

  • The CMS Innovation Center’s portfolio of models, which have attracted participation from a broad array of healthcare providers, states, payers, and other partners. An estimated 18 million individuals, including CMS beneficiaries and individuals with private insurance included in multi-payer models, have been impacted by, received care, or will soon be receiving care furnished by more than 207,000 healthcare providers participating in CMS Innovation.

  • Center payment and service delivery models and initiatives. These models are delivering care to people in every state across the nation.

  • Medicare exceeded—earlier than predicted—the goal to tie more than 30 percent of fee-for-service payments by the end of 2016 through alternative payment models to quality and cost metrics. Medicare is on pace to reach 50 percent by the end of 2018.


Future Initiatives


Moving forward, the CMMI report to Congress also noted how the Innovation Center has partnered with Medicare, Medicaid, and private health plans in the commercial market on new models of care and innovation, with a number of initiatives set to cover more beneficiaries over the next few years. Some of these include:


  • Three new payment models—the Acute Myocardial Infarction Model, the Coronary Artery Bypass Graft Model, and the Cardiac Rehabilitation Incentive Payment Model—will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation.

  • Through the Comprehensive Primary Care Plus Model, primary care doctors can care for their patients the way they think will deliver the best outcomes, and they’ll get paid for achieving results and improving care.

  • One new payment model—the Surgical Hip and Femur Fracture Treatment Model—will support clinicians in providing care to patients who undergo surgery after a hip or femur fracture beyond hip replacement. In addition,the CMS Innovation Center finalized updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.

  • The Accountable Health Communities Model, beginning in 2017, will test whether increased awareness of and access to services addressing health-related social needs will impact total health care costs and improve health and quality of care for Medicare and Medicaid beneficiaries in selected communities. This model will address a critical gap between clinical care and community services in the current delivery system.


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