Exploring Success of CMMI Value-Based Payment Models: A New Series on Innovation and Impact

While the goal is to take a deep dive into what’s working throughout our series, it’s important to understand the CMMI models we will be evaluating. Below, you’ll find brief snapshots that offer a high-level overview of the models incorporated in our evaluation. 

Accountable Health Communities (AHC) Model
Launched in 2017, AHC tested whether screening for health-related social needs and connecting beneficiaries to community services could improve outcomes and reduce costs. The model identified a high prevalence of unmet needs (i.e. housing and transportation) and helped integrate social determinants of health (SDOH) into Medicare and Medicaid workflows. Though quality measures had mixed results and healthcare cost impacts posted a modest savings of $403 million.

Bundled Payments for Care Improvement (BPCI) Initiative
Launched in 2013, BPCI tested whether bundling payments for services across a care episode could improve coordination and reduce costs. Results were not strong. While some providers achieved savings and better outcomes, others faced challenges with risk and complexity. Overall, there was no impact in quality measures, and the model increased costs $528 million over the 5 year span.

Bundled Payments for Care Improvement Advanced (BPCI-A)
BPCI-A took BPCI a step further, launching in 2018 and bundling all Medicare costs for a 90-day clinical episode into a single payment, while care is still delivered under fee-for-service. Twice a year, CMS compares total spending to a target price—providers can earn bonuses for savings or owe money if costs exceed the target—creating incentives for efficient, high-quality, coordinated care. While there was a modest $285 million in savings, the model saw little impact in terms of quality measures, which included readmissions, mortality rate, and patient experience surveys.

Comprehensive ESRD Care (CEC) Model
Launched in 2016, CEC was designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). It brought together nephrologists, dialysis facilities, and other providers to manage care for end-stage renal disease patients. The model achieved care coordination gains and did see a decrease in hospitalizations and catheter use, as well as an increase in phosphate binder adherence, but they were associated with a cost increase of $46 million. 

Comprehensive Care for Joint Replacement (CJR) Model
A mandatory model that was designed to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization or outpatient procedure through recovery. It held hospitals financially accountable for the cost and quality of hip and knee replacement episodes. CJR reduced Medicare spending and complications for lower extremity joint replacements without negatively affecting access or outcomes, making it one of CMMI’s strongest performers.  

Comprehensive Primary Care Plus (CPC+)
This five-year model was launched in 2012 as a national advanced primary care medical home model that aimed to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. It offered two primary care practice tracks with care management fees and performance incentives to primary care practices, aiming to transform care delivery. While CPC+ improved chronic disease management and reduced emergency visits and hospitalizations in some regions, its impact on total cost of care varied widely across markets.

Home Health Value-Based Purchasing (HHVBP) Model
Launched by CMMI in 2016, the HHVBP Model aimed to improve the quality and efficiency of home health services by tying Medicare payments to performance on select quality measures. The model was initially tested in nine states and evaluated whether financial incentives could drive better patient outcomes, reduced hospitalizations, and more coordinated care at home. Evaluations showed that HHVBP consistently reduced Medicare spending and improved quality performance across key metrics like timely initiation of care and patient functional status. Based on its success, CMS finalized a rule to expand the model nationally starting in 2023, marking one of the first CMMI models to be scaled system-wide.

ESRD Treatment Choices (ETC) Model

Launched in 2021, the ESRD Treatment Choices (ETC) Model is a mandatory payment model designed to increase the use of home dialysis and kidney transplants among Medicare beneficiaries with end-stage renal disease. While it aimed to promote more person-centered care, early evaluations found no significant impact on quality measures, patient experience, or disparities in outcomes. Beneficiaries reported slightly better care experiences, but effects were minimal, and financially, the model lead to an increase in total costs. 

Maryland All-Payer Model
The Maryland All-Payer Model introduced all-payer global budgets for hospitals across Maryland in 2014, aiming to control costs while maintaining quality. Under the model, Maryland hospitals committed to achieving significant quality improvements, including reductions in Maryland hospitals’ 30-day hospital readmissions rate and hospital acquired conditions rate. The model ended in 2018, and the state achieved substantial reductions in hospital readmissions and inpatient utilization, as well as $975 in cost savings, offering a model of success for hospital cost containment under state oversight.

Maryland Total Cost of Care (TCOC) Model
Expanding on the All-Payer Model, TCOC sought to limit total Medicare spending growth across all care settings. This model was the first CMMI model to hold a state fully accountable for risk for the total cost of care for Medicare beneficiaries. Maryland met its spending targets, generating almost $700 million in savings. It also saw improved coordination through primary care programs, seeing a decrease in admissions, readmissions, ED visits, and observation stays. The model is set to end as of December 2025, but will transition to the AHEAD model, which is set to launch in January 2026.

Medicare Advantage Value-Based Insurance Design (MA-VBID)
MA-VBID was designed to test MA health plan innovations that aim to enhance the quality of care for Medicare enrollees and reduce costs for enrollees and the overall Medicare program. It allowed plans to tailor benefits based on chronic conditions and social risks, testing innovations like rewards for healthy behavior and targeted supplemental services. The model expanded flexibility for MA plans and increased focus on SDOH, though evaluations noted challenges in measuring return on investment. While there was an increase in quality measure performance and patient satisfaction, the model came with a $4.5 billion price tag and is set to end December 31, 2025. 

Million Hearts® Cardiovascular Disease Risk Reduction Model
This preventive model was a randomized controlled trial that sought to bridge a gap in cardiovascular care by providing targeted incentives for health care practitioners to engage in beneficiary CVD risk calculation and population-level risk management. It encouraged providers to stratify risk and proactively manage cardiovascular health through lifestyle interventions and medication. While uptake was lower than expected, there was a minimal increase in costs and, participating providers reported improvements in clinical processes, like statin use and hypertension management.

Next Generation ACO (NGACO) Model
NGACO pushed ACOs to take on higher financial risk than available in MSSP, while granting greater flexibility in benefit design. The goal of the Model was to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, could improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries. With 35 ACOs participating, the model demonstrated savings across several years but found little impact in terms of quality measures and patient experience. 

Oncology Care Model (OCM)
OCM tested episode-based payments for chemotherapy and required 24/7 access to care, patient navigation, and treatment planning. The goal of OCM was to utilize appropriately aligned financial incentives to enable improved care coordination, appropriateness of care, and access to care for beneficiaries undergoing chemotherapy. Despite improving care coordination and patient satisfaction, the model struggled to reduce Medicare spending and faced pushback over the complexity of oncology episodes.

Part D Enhanced Medication Therapy Management (MTM) Model
This model tested whether providing Part D sponsors with additional payment incentives and regulatory flexibilities promoted enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. It allowed plans to offer customized MTM services based on patient risk, particularly targeting dually eligible and chronically ill populations. Evaluations noted improved medication adherence and modest reductions in inpatient utilization, though implementation varied widely among plans, and costs increased almost $300 million.

Pioneer ACO Model
Launched in 2012, Pioneer was one of CMMI’s earliest models, designed for high-performing providers ready for downside risk. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program. The model showed early savings and quality gains, but ended in 2016. 

Primary Care First (PCF)
PCF is a voluntary alternative five-year payment model that rewards value and quality by offering an innovative payment structure to support the delivery of advanced primary care. It focused on simplified, population-based payments to primary care practices with bonuses for performance. Early results showed mixed results in terms of quality measures, but a steep increase in net costs. 

Vermont All-Payer ACO Model
Vermont All-Payer ACO model was designed to align Medicare, Medicaid, and commercial payers under a unified ACO structure to control statewide healthcare costs. The model provided Vermont with $9.5M in start-up investment to assist Vermont providers with care coordination and bolster their collaboration with community-based providers. The model showed some success in reducing unnecessary utilization, but provider participation was uneven, and rural equity issues remain a concern.