Centers for Medicare & Medicaid Services

CMMI Evaluation Digest December 2023

Centers for Medicare & Medicaid Services sent this email to their subscribers on December 29, 2023.


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header CMS Innovation Center Evaluation Digest CMS Innovation Center Evaluation Digest December 2023 This newsletter highlights recently released Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) evaluation reports and publications. You can access reports by going to the data and reports page of the Innovation Center website. Reports highlighted in this edition: * Medicare Advantage Value-Based Insurance Design Model Year Two Evaluation Report * Million Hearts® Cardiovascular Disease Risk Reduction Model (Million Hearts® Model) Final Evaluation Report * Global and Professional Direct Contracting (GPDC) Model First Evaluation Report ---------------------------------------------------------------------------------------------------------------------------------- MEDICARE ADVANTAGE VALUE-BASED INSURANCE DESIGN MODEL YEAR TWO EVALUATION REPORT Year Two Evaluation Report - Key Takeaways: The Medicare Advantage (MA) Value-Based Insurance Design (VBID) model test enables MA insurers to offer one or more innovative benefit design options in eligible MA plans. The model aims to encourage the use of high-value care and promote healthy behavior, with goals of enhancing care quality, improving beneficiary health, and reducing spending. Most VBID benefits can be targeted based on beneficiaries’ chronic conditions or socioeconomic status (SES). A separate Hospice Benefit component is also included in the model. General Takeaways: * Model participation is growing, and interventions are increasingly focused on SES-based targeting, supplemental benefits, and Part D cost-sharing reductions. * VBID is associated with increases in beneficiary adherence, risk scores, and inpatient stays in 2020; Star Ratings and costs to the Centers of Medicare and Medicaid Services (CMS) in 2021; and premiums in 2021 and 2022. * Many outcomes evaluated were for 2020 only, a year in which COVID-19 caused major disruptions in health care provision; findings may evolve as the pandemic recedes. * Implementation has gotten easier over time, especially for insurers with more than one year of experience with VBID. Model participation is growing, and interventions are increasingly focused on SES-based targeting, supplemental benefits, and Part D cost-sharing reductions. Hospice Benefit Takeaways: * Hospice Benefit component participation is growing, but uptake of palliative care, transitional concurrent care, and hospice supplemental benefits continued to be low in 2022. * Hospices and new insurers reported substantial implementation challenges, but insurers with more than one year of experience with VBID reported fewer challenges, suggesting that implementation is becoming easier over time. * The proportion of beneficiaries receiving care from in-network hospices grew from 2021 to 2022. * Participation in the Hospice Benefit component was not associated with changes in hospice enrollment in 2021. * Participation in the Hospice Benefit component was associated with reductions in combined MAPD bids in 2021 and 2022 and reductions in combined MAPD premiums in 2021. The Two Page Overview: * Findings At-a-Glance (PDF) The Report (includes an Executive Summary): * Year Two Evaluation Report (PDF) * Go directly to the Executive Summary (PDF) Additional Supporting Materials: * Appendix: Intervention Summaries, Methodology, and Additional Analyses (PDF) * Model Page: Medicare Advantage Value-Based Insurance Design Model VBID thumbnail ---------------------------------------------------------------------------------------------------------------------------------- MILLION HEARTS® CARDIOVASCULAR DISEASE RISK REDUCTION MODEL (MILLION HEARTS® MODEL) FINAL EVALUATION REPORT Final Evaluation Report - Key Takeaways: The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model tested whether commitments to CVD preventive care and targeted incentives could lower the incidence of first-time heart attacks and strokes among Medicare beneficiaries ages 40 to 79 who had not had a previous heart attack or stroke. As part of the five-year randomized trial, participating providers used a standardized risk assessment tool to calculate their Medicare patients’ risk of having a heart attack or stroke within 10 years. Participants then received supports and incentives to reduce the CVD risk of high-risk beneficiaries, defined as those with a 30 percent or higher risk of a CVD event at baseline. Over five years, the model reduced the incidence of first-time heart attacks and strokes by 3 to 4 percent, preventing one or more events per 400 high- and medium-risk beneficiaries enrolled, and reduced the all-cause death rate. The observed effects on long-term health outcomes followed improvements in CVD preventive care, as evidenced by providers’ increased use of CVD risk assessment and beneficiaries’ increased used of statins and antihypertensive medications. The model improved CVD risk factors, such as blood pressure and cholesterol levels, and decreased CVD risk scores for high-risk beneficiaries within one year of enrollment. There were unintended effects on service use, including increased hospitalizations for all causes. The model had no measurable impact on Medicare spending. The Two Page Overview: * Findings At-a-Glance (PDF) The Report (includes an Executive Summary): * Final Evaluation Report (PDF) * Go directly to the Executive Summary (PDF) Additional Supporting Materials: * Appendix: Data, Measures, and Methods (PDF) * Model Page: Million Hearts: Cardiovascular Disease Risk Reduction Model MH Model thumbnail ---------------------------------------------------------------------------------------------------------------------------------- GLOBAL AND PROFESSIONAL DIRECT CONTRACTING MODEL FIRST EVALUATION REPORT First Evaluation Report - Key Takeaways:  The Global and Professional Direct Contracting (GPDC) Model is a voluntary, accountable care organization (ACO) model that builds on CMS’ previous ACO initiatives to improve beneficiary health outcomes, improve quality of care, and reduce costs by offering participating Direct Contracting Entities (DCEs) greater flexibility and options to take on financial risk. This report covers the first performance year (PY) 2021, which was nine months (April-December). In January 2023, continuing and new participants transitioned to the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model, as GPDC was redesigned and renamed to emphasize health equity, provider leadership, and beneficiary protections. Future evaluation reports will incorporate results from ACO REACH. In their first performance year, DCEs established a population health management infrastructure for high-priority strategies focused on reducing unnecessary utilization and investing in primary care capacity. Although the GPDC Model did not impact gross or net Medicare spending in PY 2021, Standard DCEs reduced utilization and spending in high-cost settings. New Entrants’ utilization reductions were limited to emergency departments. High Needs DCEs were not evaluated due to small sample sizes. Future evaluation reports will examine changes in implementation and impact in subsequent model years that include additional model participants who joined the GPDC Model in PY 2022 and in PY 2023 as part of ACO REACH. The Two Page Overview: * Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): * First Evaluation Report (PDF) * Go directly to the Executive Summary (PDF) Additional Supporting Materials: * Appendix: Methods, Sources, Measures and Analyses (PDF) * Model Page: Global and Professional Direct Contracting Model GPDC thumbnail ---------------------------------------------------------------------------------------------------------------------------------- Information Hand The CMS Innovation Center maintains a portfolio supporting the development and testing of innovative health care payment and service delivery models. It performs evaluations of these models and makes the results available to the public. BRINGING YOU THE LATEST CMS INNOVATION CENTER EVALUATION RESULTS: Watch out for future issues of our Evaluation Digest,  check out the CMS Innovation Center website, and follow us on Twitter. ---------------------------------------------------------------------------------------------------------------------------------- You're getting this message because you subscribed to get email updates from the Centers for Medicare & Medicaid Services (CMS). Update your subscriptions, modify your password or email address, or stop subscriptions at any time on your . You will need to use your email address to log in. If you have questions or problems with the subscription service, please contact . This service is provided to you at no charge by Centers for Medicare & Medicaid Services (CMS). ---------------------------------------------------------------------------------------------------------------------------------- This email was sent to [email protected] using GovDelivery Communications Cloud 7500 Security Boulevard · Baltimore MD 21244
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