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Ending a Sentence with a Preposition An old-fashioned rule we can no longer put up with. To date, the evidence on Medicare payment and delivery system reforms is mixed. While some CMMI models are meeting and improving upon quality goals, overall net savings to Medicare has been relatively modest, with large variations in results between the major models as well as among the individual programs within each of them. Below are the latest available results for selected models. For further details on these results, see the Kaiser Family Foundation Evidence Link —an online resource with interactive tools for comparing each model based on key features and available evidence on savings and quality.
Two CMMI models have met the statutory criteria to be eligible for expansion by reducing program spending while preserving or enhancing quality. The model concentrated on patient engagement activities for losing weight and making positive dietary choices.
The Secretary also certified the Pioneer ACO model for expansion into Medicare based on early savings and quality results. The model was extended an extra year, but to date, the Secretary has not made the Pioneer ACO model a part of the full Medicare program.
Sometimes, depending on the model. For most of the CMMI models, doctors and other providers are required to inform their Medicare patients if they are participating in a CMMI payment model, but it is not clear if their patients are typically aware of their attribution to one, or the implications for their care.
Most beneficiaries in CMMI models are in traditional Medicare and, therefore, retain their right to see any Medicare provider without financial penalty. Beneficiaries in CMMI models can also sign certain forms to prevent the sharing of their health information with other providers. To avoid being in a CMMI model altogether, Medicare beneficiaries would need to seek care from doctors and providers who are not participating in the model.
In contrast, if beneficiaries want to be part of a specific ACO, they may submit information to CMS to indicate their preference, based on who they identify as their main doctor. CMMI is currently testing the model in 10 states, and plans to expand to 25 states in In contrast, beneficiaries in ACOs do not have physician networks and can see any Medicare providers without higher cost sharing.
In some cases, however, CMMI has changed or canceled certain models—particularly ones that specify mandatory participation among hospital providers—and has announced the start of a new bundled payment model in the fall of , and the official start of the Medicare Diabetes Prevention Program in Part B.