After months of signaling that a new strategy was in the works, on May 13, 2025, the Centers for Medicare & Medicaid Services (CMS) released a new strategic direction for the CMS Center for Medicare and Medicaid Innovation (CMMI) as part of the current administration's "Make America Healthy Again" initiative.
The announcement was made through a new webpage, frequently asked questions and a white paper explaining the strategy. CMS also hosted a webinar during which Dr. Mehmet Oz (CMS Administrator) and Abe Sutton (Director of CMMI and CMS Deputy Administrator) presented the new strategy.
The new strategy is based upon three pillars:
- Promoting evidence-based disease prevention by focusing on disease prevention, detection and management in all model designs.
- Empowering people to achieve their health goals, including by featuring tools, information and processes to help connect patients to their health data and empower them to make informed decisions.
- Driving choice and competition, including by making it easier for more providers to participate in CMMI models, reducing participation burden, and requiring site-neutral payments.
The overarching goal behind each of these pillars is to protect taxpayers by reducing overall costs while improving patient health outcomes. CMMI signaled that this could mean, for example, requiring that all alternative payment models involve downside risk or that providers bear some of the financial risk of their conveners.
Moving forward, and consistent with its three pillars, CMS will incorporate features in future models that would:
- Expand the use of advanced shared savings and prospective payments, which is expected to help support independent provider practice participation in models.
- Reinvest hospital capacity in outpatient and community-based care by changing uncompetitive certificate-of-need requirements, presumably in coordination with state regulators.
- Standardize design features, such as quality measures, to reduce administrative burden.
CMS also referenced potential new waivers that do the following:
- Support predictable cost-sharing for certain services, drugs, or devices that improve outcomes and reduce costs.
- Allow for patient engagement and incentives tied to health promotion and prevention.
In addition, the strategy places emphasis on new models and opportunities for participation by rural providers and independent practices in CMMI models.
Lastly, CMS announced that it will modify its existing models and release new models to align with these new strategic goals. New models could include those in the Medicare Advantage (MA) space (potentially involving changes to payment for MA plans) or that involve multiple payers. While the timeline is not clear regarding changes to existing models or the implementation of new models, CMMI indicated this would happen "in the coming months."
CMS further stated it will evaluate "indicators of savings to the taxpayer" for all models, and it is also unclear whether CMS would terminate other existing models as part of this effort.
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