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CMS Innovation Center Evaluation Digest




*November 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:*


* Global and Professional Direct Contracting (GPDC) Model
* Kidney Care Choices (KCC) Model
* Medicare Intravenous Immune Globulin (IVIG) Demonstration





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Global and Professional Direct Contracting (GPDC) Model

*Evaluation of the Second Performance Year (2022) - Key Takeaways:*

The Global and Professional Direct Contracting (GPDC) Model was a voluntary, Accountable Care Organization (ACO) model designed to put patients at the center of their care. Building upon lessons learned from initiatives involving Medicare ACOs, such as the Medicare Shared Savings Program and the Next Generation ACO Model, this model provided greater individualized attention to a beneficiary’s specific health care needs within fee-for-service (FFS) Medicare and changed financial incentives to reward high quality care. Participants were Direct Contracting Entities (DCEs), a model-specific term for ACOs. The GPDC Model began in April 2021. New participants and continuing participants in the GPDC Model respectively started and joined the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model in January 2023.

In the second year of GPDC, the model showed mixed results in gross spending but consistent, significant increases in net spending relative to a comparison group of similar fee-for-service Medicare beneficiaries in their markets. Standard DCEs improved multiple quality measures but increased gross spending, particularly from acute care hospitalizations. New Entrants and High Needs DCEs reduced gross spending through improvements in utilization and minor improvements in quality. Future reports will provide results for new and continuing participants that transitioned to ACO REACH, with an emphasis on health equity outcomes and the model’s impacts on underserved communities.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/gpdc-2nd-ann-report-aag ]

*The Report (includes an Executive Summary):*


* Evaluation of the Second Performance Year (2022) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/gpdc-2nd-ann-report ]
* The Executive Summary starts on page 9

*Additional Supporting Materials:*


* Appendix: Research Questions, Measures, Data, and Methods (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/gpdc-2nd-ann-report-app ]
* Model Page: Global and Professional Direct Contracting (GPDC) Model [ https://www.cms.gov/priorities/innovation/innovation-models/gpdc-model ]
* Related Model  Page: Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model [ https://www.cms.gov/priorities/innovation/innovation-models/aco-reach ]
GPDC 2nd Annual Report - Findings At-a-Glance (PDF)

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Kidney Care Choices (KCC) Model

*Evaluation Findings for Performance Year (PY) 2022 - Key Takeaways:*

Kidney Care Choices (KCC) is a voluntary model designed to improve care management for Medicare patients with chronic kidney disease (CKD) Stage 4 or 5 and end-stage renal disease (ESRD). KCC aims to delay the onset of dialysis and improve dialysis starts, increase home dialysis, increase kidney transplantation, reduce Medicare expenditures, and preserve or enhance quality of care. Participants choose to join one of two model options. *Kidney Care First (KCF)* is available to nephrology practices and their nephrologists and nephrology professionals only. *Comprehensive Kidney Care Contracting (CKCC)* is available to nephrology practices that team with a transplant provider and optional partners such as dialysis facilities to form Kidney Contracting Entities (KCEs). The first KCC cohort began participating in January 2022, and a second and final cohort joined in January 2023.

In the first performance year of the KCC Model, consisting of Cohort 1 participants, home dialysis in KCF and home dialysis training in CKCC increased. The model increased Optimal ESRD Starts in CKCC, although most other quality measures were unchanged. There was no evidence of impacts on overall Medicare payments, net savings or losses to Medicare, or unintended consequences. Given the challenges of increasing home dialysis and transplant rates and the early stage of the model implementation, it is too early to form conclusions about possible longer-term impacts of the model.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/kcc-model-eval-ann-rpt-1-aag ]

*The Report (includes an Executive Summary):*


* Evaluation Findings for Performance Year (PY) 2022 (PDF) [ https://www.cms.gov/kcc-model-eval-ann-rpt-1 ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/kcc-model-eval-ann-rpt-1-exec ]

*Additional Supporting Materials:*


* Appendix: Methodology and Supplemental Analyses (PDF) [ https://www.cms.gov/kcc-model-eval-ann-rpt-1-app ]
* Model Page: Kidney Care Choices (KCC) Model [ https://www.cms.gov/priorities/innovation/innovation-models/kidney-care-choices-kcc-model ]
KCC Model Evaluation Findings for Performance Year (PY) 2022 (PDF)

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Medicare Intravenous Immune Globulin (IVIG) Demonstration

*Final Report to Congress (2014 - 2023) - Key Takeaways: *

Congress established the Medicare Intravenous Immune Globulin (IVIG) Demonstration which was conducted from October 2014 through December 2023. The purpose of the demonstration was to evaluate the benefits of providing payment for items and services needed for the in-home administration of IVIG for Medicare beneficiaries with specific Primary Immunodeficiency Disorders (PIDD). The demonstration provided a bundled payment for items and services involved with the in-home administration of IVIG therapy for Medicare beneficiaries with specific PIDD diagnoses.

In December 2022, Congress passed legislation making in-home IVIG infusions a permanent Medicare benefit for PIDD patients, effective January 2024.

The reports’ key findings with respect to the demonstration impact on beneficiary access to IVIG, beneficiary health, and overall costs to Medicare are summarized below:


* Improved access: Demonstration enrollees reported better access to IVIG therapy and less trouble obtaining their Immune Globulin treatments.


* Improved health outcomes: Demonstration enrollees were significantly less likely to get infections, have hospitalizations, or receive services for infections or pneumonia.


* Increased costs: Overall annual Medicare costs were higher among active Demonstration participants, relative to the comparison group.

*The Two Page Overview:*


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

*The Report (includes an Executive Summary):*


* Final Report to Congress (2014 - 2023) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ivig-final-rtc ]
* The Executive Summary starts on page 5

*Additional Supporting Materials:*


* The Appendix starts on page 19
* Model Page: Medicare Intravenous Immune Globulin (IVIG) Demonstration [ https://www.cms.gov/priorities/innovation/innovation-models/ivig ]
IVIG Model Final Report to Congress (PDF)





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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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