On March 12, 2025, the Center for Medicare and Medicaid Innovation (CMMI) announced it was ending four Biden administration payment models early. No reason was provided other than the changes were to “align its statutory mandate and strategic goals.” CMMI wants to end these models by Dec. 31, 2025, and most of the models selected for early termination are within two years of their end date. The center also said that by ending the models early, it expects to save taxpayers $750 million. In addition, CMMI also announced other changes.
CMMI will end:
- Maryland Total Cost of Care model which began in 2019 and allowed the state to cap hospital expenditures. Participants will transition to the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. That model is a state total cost of care model that seeks to drive state and regional health care transformation and multi-payer alignment, with the goal of improving the total health of a state population and lowering costs. Maryland had operated under the All-Payer Model focused on hospitals, but it did not sufficiently provide for comprehensive coordination across the entire health care system. Because of that limitation, the federal government required Maryland to develop a new model to encompass all of the health care patients receive both in and out of the hospital.
- Primary Care First which increases payments for physicians if they meet quality metrics such as controlling high blood pressure and increasing cancer screenings. It will end after 2025.
- Making Care Primary which is a voluntary model that started last year. It is designed to increase coordination between primary care doctors, specialists and behavioral health clinicians to improve health outcomes. Originally, the model was to run for 10 years, but it will now end early although the Centers for Medicare and Medicaid Services (CMS) did not specify when.
- End-Stage Renal Disease Treatment Choices, a mandatory model designed to increase home dialysis use. CMS intends to issue a rule to terminate the model by the end of the year.
CMMI also plans to unveil a new strategy based on guiding principles to make “Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition.” This appears to signal a change in CMMI’s focus: less on quality improvement as the Biden administration had, and more on savings.
In addition, CMS announced it will no longer pursue implementation of the Medicare $2 generic drug list or the Accelerating Clinical Evidence model. CMS is also considering options to reduce the size of the Integrated Care for Kids awards or make other changes to the model.
