CMS Innovation Center Evaluation Digest - August 2020

August 2020 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 data and reports page of the Innovation Center website. Reports highlighted in this edition: Episode Payment Models Evaluation Synthesis Bundled Payments for Care Improvement Initiative (BPCI) Models 2-4 Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model

Episode Payment Models Evaluation Synthesis White Paper Key Takeaways: CMS conducted an analysis of nine available evaluation reports that look at results for seven episode payment models to identify common themes, determine lessons learned, and highlight best practices. Of the episode payment model results reviewed, some have shown reductions in utilization and episode costs without compromising quality. However, despite decreased utilization and lower expenditures in some of these episode payment models, to date, model evaluations typically observe no net savings to Medicare, due to how target prices, discounts, and risk-sharing arrangements have been set. The White Paper (includes an Executive Summary): White Paper Synthesis (PDF) Additional Supporting Materials: Bundled Payments for Care Improvement (BPCI) Initiative: General Information Comprehensive Care for Joint Replacement Model Oncology Care Model

Bundled Payments for Care Improvement Initiative (BPCI) Models 2-4 Year 6 Evaluation and Monitoring Annual Report Key Takeaways: Consistent with previous reports, the Bundled Payments for Care Improvement (BPCI) initiative independent evaluation found that BPCI resulted in reduced Medicare FFS payments for the majority of clinical episodes evaluated while maintaining the quality of care for Medicare beneficiaries. A new analysis found that the approach to reducing Fee for Service payments differed by provider type for surgical and medical clinical episodes. Despite these encouraging results, Medicare experienced net losses under BPCI after taking into account reconciliation payments to participants, as in previous reports. Technical implementation issues, including the specification of appropriate target prices, may have contributed to these net losses. When BPCI ended, CMS began a new episode - based Advanced Alternative Payment Model, BPCI Advanced, which addresses some of the challenges of the original BPCI model. It remains to be seen whether BPCI Advanced will achieve net savings for Medicare. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Year 6 Evaluation and Monitoring Annual Report (PDF) Go directly to the Executive Summary (PDF) Additional Supporting Materials: Appendices (PDF) - Methods discussion, supporting tables, and impact estimates for payment, utilization, and quality measures broken down by clinical episode and initiator type Model Page: Bundled Payments for Care Improvement (BPCI) Initiative: General Information

Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model Year One Evaluation Annual Report Key Takeaways: There was generally broad participation in BPCI Advanced among hospitals and Physician Group Practices (PGPs). Most participating hospitals and PGPs joined the model as downstream Episode Initiators (EIs) under a convener participant and many cited similar reasons for entering the model. Although there was participation in all 32 clinical episodes, most EIs chose to participate in fewer than five. Hospital EIs had higher median historical payments for the clinical episodes they chose than hospitals that were eligible but chose not to participate. Future reports will incorporate estimates of the impact of the model on payments, utilization and quality of care, and Medicare program savings, in addition to beneficiary-reported outcomes on functional status and satisfaction. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Year One Evaluation Annual Report (PDF) Go directly to the Executive Summary (PDF) Additional Supporting Materials: Appendices (PDF) - Includes methods and supplemental tables Model Page: BPCI Advanced

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, and follow us on Twitter.