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CMS Innovation Center Evaluation Digest




*June 2024*

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 evaluations and research reports page [ https://www.cms.gov/priorities/innovation/evaluation-research-reports ] of the Innovation Center website [ https://www.cms.gov/priorities/innovation/overview ].




*Reports highlighted in this edition:*


* Maryland Total Cost of Care (MD TCOC) Model
* Value in Opioid Use Disorder Treatment (VIT-OUD) Demonstration
* Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model





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Maryland Total Cost of Care (MD TCOC) Model

*Evaluation of the First Four Years (2019–2022) - Key Takeaways:*

Under the Maryland Total Cost of Care (MD TCOC) Model, the state has committed to save $2 billion in Medicare spending over eight years and to meet goals for health care quality and population health. The MD TCOC Model (2019 to 2026) builds on the Maryland All-Payer Model (MDAPM) (2014-2018), which began all-payer hospital global budgets. The MD TCOC Model continues global budgets and introduces new components, including significant investment in primary care, to engage a wider range of providers in care transformation throughout the state.

During the MD TCOC period, the model reduced Medicare fee-for-service spending by 2.1%, reduced hospital admissions by 16.2%, and reduced disparities in several quality measures. From 2019 to 2021, the model reduced total Medicare spending - including non-claims payments - by $689 million. These effects represent the combined effects of all the changes that CMS and Maryland have made since 2014. Effects were likely driven in large part by hospital responses to global budgets, which reverse traditional fee-for-service incentives and reward hospital efforts to reduce preventable hospital care. Beyond the other model components, advanced payments to practices via the Maryland Primary Care Program (MDPCP) reduced hospital use modestly but strained statewide savings. On average, MDPCP cost CMS about $96 million annually but did not generate any statistically significant savings to offset its costs. The evaluation will continue to examine the model’s impacts on spending, service use, and quality.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/md-tcoc-1st-progress-rpt-aag ]

*The Report (includes an Executive Summary):*


* Evaluation of the First Four Years (2019-2022) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/md-tcoc-1st-progress-rpt ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/md-tcoc-1st-progress-rpt#page=19 ]

*Additional Supporting Materials:*


* Appendix: Data, Measures, and Methods (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/md-tcoc-1st-progress-rpt-app ]
* Transformation Spotlight: Insights from the first four years (2019–2022) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/md-tcoc-transformation-spotlight ]
* Model Page: Maryland Total Cost of Care Model [ https://www.cms.gov/priorities/innovation/innovation-models/md-tccm ]
MD TCOC At-a-Glance Report thumbnail image

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Value in Opioid Use Disorder Treatment (VIT-OUD) Demonstration

*Intermediate Report to Congress (2021–2022) - Key Takeaways:*

The Value in Opioid Use Disorder Treatment (VIT-OUD) Demonstration aims to test whether specialized opioid use disorder (OUD) care teams, supported by two new payments, can increase access to OUD treatment services, improve health outcomes, and reduce Medicare expenditures. The demonstration was required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act). It started on April 1, 2021, and is expected to end on December 31, 2024.

Interim findings show that the VIT-OUD Demonstration was associated with improvements in important clinical and economic outcomes. Hospitalizations, emergency department (ED) visits, and Medicare expenditures were all lower among VIT-OUD beneficiary enrollees than among a matched comparison group. Considering the high mortality and morbidity rates associated with OUD, and the challenges of engaging patients in high-quality treatment, these findings are promising. However, the findings are also surprising because the VIT-OUD Demonstration was not associated with an impact on the use of for Medications to treat Opioid Use Disorders (MOUD)s, and MOUD use has previously been shown to reduce hospitalizations and ED visits. Without qualitative data to explain the findings, it is unclear how the demonstration has had these impacts. Although the use of MOUDs was not different from that of a matched comparison group, VIT-OUD beneficiary enrollees did have high use of MOUDs both before and after enrolling in the demonstration. Thus, these findings may not generalize to a population without a history of MOUD use or to a population with lower engagement with MOUDs.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vit-intermediate-rtc-aag ]

*The Report (includes an Executive Summary):*


* Intermediate Report to Congress (2021-2022) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vit-intermediate-rtc ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vit-intermediate-rtc#page=5 ]

*Additional Supporting Materials:*


* Appendix: Comparison Group Approach, Question-by-Question Analytic Approach, and Measure Specifications (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vit-intermediate-rtc#page=27 ]
* Model Page: Value in Opioid Use Disorder Treatment (VIT-OUD) Demonstration [ https://www.cms.gov/priorities/innovation/innovation-models/value-in-treatment-demonstration ]
VIT OUD At-a-Glance Report thumbnail image

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Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model

*Evaluation of Model Year 4 (January 2021–December 2021) - Key Takeaways: *

The Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model tests whether holding participants financially accountable for the cost and quality of health care services during an episode can reduce Medicare spending while maintaining or improving quality of care.

Episodes begin with a hospital stay or an outpatient procedure initiated by a participating hospital or physician group practice (PGP) and end 90 days after discharge.

Model participants can earn a reconciliation payment if episode payments are below their target price, or they may be required to repay Medicare if episode payments are above their target price, after considering the quality of their care. This payment approach encourages participants to coordinate care across all providers involved in the episode.

For the first time since its inception in the fourth quarter (Q4) of 2018, the BPCI Advanced Model resulted in net savings to Medicare, estimated to be $465 million (or 3.4% of what Medicare payments would have been had the model not existed), offsetting losses in earlier model year.

After the design changes in Model Year 4, the number of unique participants declined, but the remaining hospitals and PGPs were accountable for more clinical episodes.

*The Two Page Overview:*


* Findings-At-A-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/bpci-adv-ar5-aag ]

*The Report (includes an Executive Summary):*


* Evaluation of Model Year 4 (January 2021-December 2021) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/bpci-adv-ar5 ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/bpci-adv-ar5#page=6 ]

*Additional Supporting Materials:*


* Appendix: Methods, Characteristics, and Results (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/bpci-adv-ar5-appendices ]
* Model Page: Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model [ https://www.cms.gov/priorities/innovation/innovation-models/bpci-advanced ] [ https://www.cms.gov/priorities/innovation/innovation-models/comprehensive-primary-care-plus ]
BPCI Advanced Model At-a-Glance Report thumbnail image





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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 [ https://innovation.cms.gov/ ],
and follow us on Twitter [ https://twitter.com/CMSinnovates ].









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