CMS Innovation Center Evaluation Digest - November 2020

 

 

November 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: Prior Authorization Model For Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT) Medicare Advantage (MA) Value Based Insurance Design (VBID) Model Next Generation Accountable Care Organization (NGACO) Model

 

Prior Authorization Model For Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT) Second Interim Evaluation Report Key Takeaways: The Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization model was successful in reducing RSNAT and total Medicare spending while maintaining overall quality of and access to care levels. Through the use of prior authorization, the model dramatically reduced both RSNAT service use and RSNAT expenditures, by 63% and 72%, respectively, resulting in a reduction of approximately $550 million in RSNAT service expenditures and total Medicare savings of $650 million for beneficiaries with ESRD and/or severe pressure ulcers. Overall, our quantitative analysis suggests no impact on observed quality and access as measured by emergency department visits, emergency ambulance use, unplanned inpatient admissions, and death. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Second Interim Evaluation Report (PDF) Go directly to the Executive Summary (PDF) Additional Supporting Materials: Appendices (PDF) - Methodological descriptions and additional quantitative analysis results Press Release - CMS to Expand Successful Ambulance Program Integrity Payment Model Nationwide Office of the Actuary - Certification Memo Model Page: Prior Authorization Model For Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT)

 

Medicare Advantage (MA) Value Based Insurance Design (VBID) Model Evaluation Report of the First Three Years (2017–2019) Key Takeaways: The Value Based Insurance Design (VBID) Model was associated with increased use of many high-value services targeted by the participating Medicare Advantage Parent Organizations such as primary care physician visits, specialist visits for targeted conditions, and 30-day drug refills. VBID was also associated with reduced Part D bids. However, longer follow-up is needed to detect changes on other key outcomes, such as quality and health outcomes. Plans’ benefit designs varied widely, making it difficult to determine which design components had the biggest impact. Overall, VBID is not yet generating savings but is also not costing Medicare additional money, as expected. Substantial changes to the VBID model and plan participation began with the 2020 plan year. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Evaluation Report of the First Three Years (2017-2019) Go directly to the Executive Summary (PDF) Additional Supporting Materials: CMS Perspective (PDF) - CMS’s review of the evaluation report findings and discussion of selected next steps. Appendices (PDF) - Methods descriptions, a telehealth case study, and supportive analyses that offer a more detailed look at results on a variety of topics Model Page: Medicare Advantage (MA) Value Based Insurance Design (VBID) Model

 

Next Generation Accountable Care Organization (NGACO) Model Third Evaluation Report Key Takeaways: In its first three years, the NGACO model achieved a $349 million reduction in Medicare Parts A and B gross spending. Although the model was associated with reductions in part A and B spending relative to a comparison group, after including CMS payments for shared savings and coordinated care rewards (CCRs), the net spending impact of the model was a non-statistically significant $118 million increase in spending. The model was associated with reduced PAC and professional services spending but saw no appreciable declines in hospital utilization and spending. There were substantive differences in the spending impact among the three NGACO cohorts which contributed to the overall gross and net impact of the model. The model’s spending impact was unevenly distributed among the three NGACO cohorts owing to differences in number of beneficiaries, average spending impact, and duration of participation in the model. The 2017 cohort accounted for over half of the total model-wide decline in part A and B spending during its two years of participation in the model. Higher model-wide net spending in the first three years was mostly due to the 2016 cohort, which had a statistically significant +$178 million increase in net spending. Quality of care remained constant. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Third Evaluation Report (PDF) Go directly to the Executive Summary (PDF) Additional Supporting Materials: CMS Perspective (PDF) - CMS’s review of the evaluation report findings and discussion of selected next steps. Appendices (PDF) - Methodological descriptions and supporting exhibits Model Page: Next Generation ACO Model Related Model Page: Direct Contracting Model Options, Pioneer ACO Model

 

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.