Medicare Monday: Have you heard of CMMI?

There are a number of acronyms commonly used in the health care world, which can often be confusing and complicated, so this week we’re tackling one of them: CMMI.

 CMMI, the Center for Medicare and Medicaid Innovation, is housed within the Centers for Medicare & Medicaid Services. Created in 2010 as part of the Affordable Care Act, CMMI was established to test new models for paying for and delivering health care in the Medicare, Medicaid and CHIP programs. Among the criteria necessary for a model to be eligible for expansion is whether it is successful at either reducing costs without harming quality or improving quality without increasing costs.

The Center is currently testing more than 40 programs in Medicare and Medicaid, many of which are alternative payment models, such as bundled payments, patient-centered medical homes and accountable care organizations. However, the way CMMI is structured raises serious concerns.

• CMMI has broad flexibility to test changes to the Medicare law with few limits on the size or duration of its model tests. This gives the Center power to make broad, far-reaching changes.
• Though CMMI is supposed to go back to Congress for approval before expanding models that change Medicare or Medicaid laws, historically CMMI has failed to do so.
• CMMI is required to seek input from interested parties as it develops and tests models, but has been inconsistent in when and how it engages stakeholders.

You may recall one proposal from 2016 to alter the way the majority of providers nationwide are reimbursed for medicines within the Medicare Part B program. A large number of stakeholders across the health care system and members of Congress expressed concern that this proposal would harm patients and was an example of the Center overstepping its authority. In the end, the agency decided not to implement the program.

When testing new payment models, we must ensure we are protecting quality and patient access to needed care. Many stakeholders are now calling for CMMI to be reformed with additional safeguards to protect patients and make the Center more accountable, while preserving its ability to innovate and test new policies.

Learn more about CMMI and the importance of safeguarding CMMI on our new webpage.

And in case you missed it, last week we tackled a different acronym – IPAB. Check out that blog post here.