Scoop: Trump Medicare center to cancel some payment trials
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The Trump Medicare innovation center plans to cancel a half dozen trials to change the way health providers are paid by the end of the year as it aligns itself with the goals of the Make America Healthy Again movement, multiple people familiar with the plans told Axios.
The big picture: Center for Medicare and Medicaid Innovation leadership said they want to focus on models that are likely to meet criteria for expansion and that promote the goals of HHS Secretary Robert F. Kennedy Jr.'s public health agenda, said a person with knowledge who was granted anonymity to speak freely.
What they're saying: CMMI "is committed to testing — and eventually scaling — innovative payment models that meet the statutory goals of reducing program spending while maintaining or improving quality of care," a CMS spokesperson said.
- The center has completed a data-driven review of models based on their statutory mandate and identified some that will conclude as scheduled and others that should be terminated, the spokesperson said.
- CMS estimated the changes will save taxpayers almost $750 million, though it did not specify how.
State of play: The innovation center will end two payment models focused on alternative ways to pay for primary care — Making Care Primary and Primary Care First — and an experiment to encourage at-home dialysis and kidney transplants known as End-Stage Renal Disease Treatment Choices.
- "Primary care remains a foundational component of the Center's strategy," CMMI wrote in a fact sheet on Wednesday.
- "The early termination ... does not signal a retreat from the center's support of primary care providers, but rather a need to focus on different approaches that are consistent with the CMS Innovation Center's statutory mandate and produce savings."
- CMMI will also end the Maryland Total Cost of Care Model one year early. The model builds on an alternative payment structure Maryland has used for over a decade now in which hospitals in the state get a fixed amount of revenue from payers each year.
- Maryland has already been chosen to participate in a broader total cost of care model known as AHEAD starting in 2026. CMMI plans to continue that model, a source familiar told Axios.
CMMI will also not continue with two projects that had been announced but not yet started. One would offer $2 generic drugs to Medicare beneficiaries. A second aimed to incentivize drug manufacturers to complete confirmatory trials of accelerated approval drugs.
- The center said Wednesday that it is also considering options to reduce the size or make other changes to a model aimed at integrating care for children.
- An experiment to redesign care delivery in Vermont and one aimed at improving care for pregnant and postpartum Medicaid beneficiaries with opioid use disorder are already slated to conclude at the end of 2025.
Between the lines: CMMI said in a fact sheet that it has determined its other models can continue, either as-is or with modifications.
Context: The innovation center was created through the Affordable Care Act to test different ways to provide and reimburse for health services. It runs limited-time pilots aimed at improving patient care and lowering costs, with a goal of adapting successful policies for Medicare and Medicaid as a whole.
- The center currently operates 23 models. CMMI gets $10 billion in mandatory funding each decade to develop, test and evaluate different experiments.
Some of the models set for cancellation have not yet shown to improve care or decrease costs.
- The model aimed at improving renal disease care has not affected health outcomes or Medicare spending, per its latest evaluation.
- Primary Care First, which tests performance-based payment for advanced primary care services, has had "minimal effects on hospitalizations and Medicare expenditures," according to its most recent evaluation, though the report says that's to be expected at the model's current stage.
Yes, but: The Maryland Total Cost of Care Model saved a net $689 million for Medicare in its first three years and reduced hospital admissions.
Reality check: It's common for a new administration to end or modify some Medicare payment projects early in its term.
- But the back-and-forth can make it hard for providers to fully invest in participating in these payment experiments.
What we're watching: The innovation center plans to announce a new strategy "based on guiding principles to make Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition," the CMS spokesperson said.
