Following the announcement that four Center for Medicare and Medicaid Innovation (CMMI or Innovation Center) models will end in 2025, the Centers for Medicare & Medicaid Services (CMS) has begun signaling what's next for the Innovation Center. Last week, CMMI Director Abe Sutton and CMS Administrator Dr. Mehmet Oz outlined a new strategic direction built around several core pillars.
Though not a fully developed strategy, the new framework offers insight into the types of models CMMI may pursue. Key focus areas include:
- advancing evidence-based prevention
- expanding model activity in Medicare Advantage, Medicaid and drug pricing
- prioritizing cost savings and financial accountability
- increasing access to consumer-facing tools and data
- supporting independent and rural providers
- promoting choice and competition
Emphasis on Savings
CMMI is now placing a stronger emphasis on generating cost savings. The administration appears to view models that do not reduce costs as falling short of expectations.
Shift Toward Mandatory Participation
Sutton suggested CMMI may increasingly use its authority to require participation in new models – marking a significant shift from the largely voluntary approach taken to date. Currently, mandatory models are limited, with the Transforming Episode Accountability Model (TEAM) being a rare example.
Increased Financial Risk for Physicians
Future physician-focused models are expected to include downside financial risk from the start. Sutton underscored the agency's goal of maximizing participation in value-based arrangements that include such risk.
What It Means for Stakeholders
Participants in current models should prepare for possible changes to model design and expansion to new populations. Attribution and beneficiary consent processes may need to be reworked to support broader, potentially mandatory participation.
CMMI also appears to be creating new opportunities for nontraditional providers, including artificial intelligence (AI) vendors and care management platforms. Streamlining quality reporting and aligning measurement efforts with the administration's deregulatory agenda could create space for these organizations to demonstrate value in future models.
More Information
- White Paper: CMS Innovation Center Strategy to Make America Healthy Again
- FAQs
- CMS Blog: Making America Healthy Again: Innovation for Healthier Lives
- Webinar: CMS Innovation Center's 2025 Strategy to Make America Healthy Again (PDF slides) | Recording (MP4)
- Innovation Center Strategic Direction Archive
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