Independence at Home: Year Nine Evaluation Report

March 2025

The Independence at Home (IAH) Demonstration was launched in 2012 through Section 3024 of the Patient Protection and Affordable Care Act. Under the demonstration, physician- and nurse-led teams provide primary care services in the homes of beneficiaries with chronic illness and functional limitations. IAH practices receive a payment incentive if they generate savings above an established threshold and meet quality-of-care targets. This evaluation report covers the first nine years of the demonstration and examines the IAH incentive payment’s effects on spending, utilization, and quality during 2022, the third year of the COVID-19 pandemic.Read more

Medicare Advantage Value-Based Insurance Design Model Evaluation Report: 2020 to 2023 (PDF)

March 2025

Participation in VBID General has increased substantially since Phase II of the model test began, in part due to statutory expansion of the model nationwide and opening participation to special needs plans. Reduced cost sharing for Part D and supplemental benefits dominated VBID General offerings in 2023. VBID General is associated with increases in beneficiary drug adherence, risk scores, and inpatient stays in 2020 and 2021, and Star Ratings and costs to CMS in 2021 and 2022. VBID Hospice participation continued to grow, but uptake of model services continued to be low in 2023.Read more

Medicare Diabetes Prevention Program (MDPP) Expanded Model Final Annual Evaluation Report

March 2025

During the first six years of the program (April 2018-March 2024), MDPP suppliers enrolled just over 9,000 beneficiaries, with about half being in Medicare Advantage and the other half in traditional fee-for-service Medicare.  More than half of beneficiaries met the 5% weight loss goal. Among those who lost at least 5% of body weight and stayed in the program, over 80% maintained or lost additional weight by the end of the program.  MDPP beneficiaries are satisfied with the program and have reported short-term benefits such as improvements in body fat, cholesterol, and A1c levels.  However, effects on population health are limited given low program enrollment.Read more

Emergency Triage, Treat, and Transport (ET3) Model - Final Evaluation Report (PDF)

January 2025

During its three-year duration, less than 40% of the model’s 185 participant ambulance suppliers and providers delivered any Transport to Alternative Destination (TAD) or Treatment In Place (TIP) ET3 interventions because of implementation challenges. TIP made up nearly all of the 3,418 ET3 interventions delivered (>90 percent). TIP recipients had a higher risk of subsequent emergency department (ED) visits or hospitalizations within 5 days compared to referent group episodes. Participant organizations that delivered at least 100 ET3 interventions during the model exhibited a lower risk of subsequent ED visits or hospitalizations than participants with fewer than 100 ET3 interventions.Read more

State Innovation Models Initiatives - Final Summary Report (PDF)

January 2025

The CMS Innovation Center awarded funding to 17 awardees across two rounds of the State Innovation Model (SIM) that operated between 2013-2020. This paper summarizes qualitative and quantitative findings to expand the evidence base for state-based models including the role states can play in spreading value-based payment, policy and implementation lessons learned, and the relevance of these findings for successive Innovation Center models.Read more

Comprehensive Care for Joint Replacement Model: Sixth Annual Report

December 2024

The CJR Model underwent significant model changes for the sixth performance year. The model achieved Medicare savings marking a return to the prior pattern of savings in the first four years of the model. CJR hospitals reduced the cost of joint replacements while maintaining quality of care for the sixth consecutive year. Hospitals reduced costs by sending patients to less intensive post-acute care settings. Since CMS removed outpatient knee, ankle, and hip replacements from the inpatient-only list, these procedures are now all performed largely in the outpatient setting. This report also explores factors that impacted hospitals' experiences in the model, including strategic alignment with Medicare ACOs and the unique experiences of safety-net hospitals.Read more

Drivers of Impact: Insights from the Evaluation of Comprehensive Care for Joint Replacement Model

December 2024

This report summarizes the story of the CJR Model to date, with emphasis on findings from the latest performance year. The model reduced the cost of joint replacements while maintaining quality of care for the sixth consecutive year. Hospitals reduced costs by sending patients to less intensive post-acute care settings. CJR hospitals continued to change patterns of care before, during, and after the joint replacement procedure to better prepare patients for a safe discharge home. By making hospitals accountable for rehabilitation, providing them with information about the use and cost of care beyond the hospital stay, and allowing them to share in the savings to Medicare, the CJR Model gave providers both the means to drive better value and the incentive for doing so. Read more

Drivers of Care Transformation: Evaluation of the Comprehensive Care for Joint Replacement Model

December 2024

The CJR Model provides evidence that payment incentives that hold providers accountable for a well-defined and clinically meaningful episode of care can motivate transformative changes to patient care. The CJR Model not only motivated better coordination across providers but also encouraged innovation in protocols that guide how care is delivered and the pathways that define the patient’s journey. CJR hospitals focused on reducing unnecessary care and engaging patients so they could be well informed and physically prepared for surgery and recovery. Hospitals developed more presurgery education programs and prescribed physical therapy before and after surgery. They also revised postdischarge strategies and strengthened provider relationships to reduce institutional stays and get patients home sooner after their surgery. This report explores how and why CJR hospitals transformed care for patients. Read more

CMS Innovation Center - Seventh Report to Congress (PDF)

December 2024

The CMS Innovation Center (CMMI) released the 2024 Report to Congress (RTC) (PDF). During the period of report, more than 192,000 providers and/or plans participated in CMS Innovation Center models and initiatives, serving more than 57 million beneficiaries. This seventh report features strategic accomplishments, updates on 37 models and initiatives (including 9 newly announced models), 52 evaluations, and more activities from October 1, 2022 through September 30, 2024.Read more

Preview of Findings from the Evaluation of the “VBID General” Component of the Medicare Advantage Value-Based Insurance Design Model (2020 – 2023) (PDF)

December 2024

This document, along with the related accompanying report, comprise an executive summary of the forthcoming evaluation report for VBID and a report summarizing additional analyses of 2023 evaluation report findings. These materials offer additional detail on the evaluation findings that informed the termination of the VBID model at the end of 2025. Building on the 2023 evaluation report finding of increased costs associated with the VBID model in 2021, the executive summary of the forthcoming evaluation report indicates continued increased costs associated with the VBID model. CMS’ additional analyses of 2023 evaluation findings provide more detail on the association between VBID participation and higher enrollee risk scores. These analyses conclude that the association between VBID plan participation and higher enrollee risk scores was seen across subsets of the model and that the increased prevalence of Hierarchical Condition Categories (HCCs) drove the risk score increase associated with the model.Read more