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CMS Innovation Center Evaluation Digest




*August 2024*

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 evaluations and research reports page [ https://www.cms.gov/priorities/innovation/evaluation-research-reports ] of the Innovation Center website [ https://www.cms.gov/priorities/innovation/overview ].




*Reports highlighted in this edition:*


* Oncology Care Model (OCM)
* Maternal Opioid Misuse (MOM) Model
* Vermont All-Payer ACO Model (VTAPM)





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Oncology Care Model (OCM)

*Final Evaluation: Performance Periods 1 to 11 - Key Takeaways:*

OCM encouraged participating practices to improve care and lower costs through an episode-based payment model that financially incentivized high-quality, coordinated care. The Oncology Care Model tested a two-part payment system: CMS provided Monthly Enhanced Oncology Services (MEOS) payments of $160 per month during 6-month chemotherapy episodes to assist participating practices in effectively managing and coordinating care. Performance-based payments incentivized practices to lower the total cost of care and improve quality for beneficiaries during chemotherapy episodes.

The final evaluation report focuses on OCM impacts on Medicare payments, utilization, and quality outcomes based on quantitative and qualitative analyses through the entire course of the OCM model.

OCM reduced average total episode payments, primarily through improved use of high-value supportive care drugs among higher-risk cancer types. These reductions were offset by model incentive payments, resulting in net losses, though net losses diminished over time as payment reductions grew. Practice-reported process measures of quality improved, but this did not translate to improved patient-report or claims-base quality outcomes.

The report includes a companion report that illustrates the cancer care journey through the stories of 30 patients and highlights what matters to people undergoing cancer treatment.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-final-eval-report-2024-aag ]

*The Report (includes an Executive Summary):*


* Final Evaluation: Performance Periods 1 to 11 (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-final-eval-report-2024 ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-final-eval-report-2024-exec-sum ]

*Additional Supporting Materials:*


* Appendix: Data and Methods [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-final-eval-report-2024#page=104 ]
* Supplemental Appendix: Additional Detailed Findings (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-final-eval-report-2024-supp-app ]
* Patient Perspectives Report: Cancer Care Experiences Among People Covered by Medicare (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-final-eval-report-2024-patient-persp ]
* Model Page: Oncology Care Model [ https://www.cms.gov/priorities/innovation/innovation-models/oncology-care ]
* Related Model Page: Enhancing Oncology Model [ https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model ]
OCM 6th AR AGG thumbnail

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Maternal Opioid Misuse (MOM) Model

*Evaluation of the First Five Performance Years (2018-2022) - Key Takeaways:*

The MOM Model is a patient-centered service delivery model that aims to improve the quality of care for pregnant and postpartum Medicaid patients with opioid use disorder (OUD) and their infants. The CMS Innovation Center supported awardees in seven States (Colorado, Indiana, Maine, New Hampshire, Tennessee, Texas, and West Virginia) to implement the MOM Model with one or more care delivery partners during the second year of implementation.

This third annual report describes activities that the MOM Model awardees undertook during the MOM Model’s second implementation year (July 2022 - June 2023).

Model enrollment nearly doubled, yet barriers experienced by patients and providers impact model accessibility and expected enrollment. Model providers adopted clinical best practices to treat pregnant people with OUD; peer recovery services is emerging as a promising practice based on 158 interviews and 47 patient perspectives. Care delivery partners developed service capacity to care for Model patients, although have made limited progress establishing sustainable service payment mechanisms following the demonstration.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/mom-third-ann-eval-aag-rpt ]

*The Report (includes an Executive Summary):*


* Evaluation of Implementation Year 2 (July 2022−June 2023) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/mom-third-ann-eval-rpt ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/mom-third-ann-eval-rpt#page=8 ]

*Additional Supporting Materials:*


* Appendix: Research Questions, Data, Characteristics, and Best Practices (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/mom-third-ann-eval-rpt#page=113 ]
* Model Page: Maternal Opioid Misuse (MOM) Model [ https://www.cms.gov/priorities/innovation/innovation-models/maternal-opioid-misuse-model ]
MOM Final Evaluation Report AAG

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Vermont All-Payer ACO Model (VTAPM)

*Evaluation of the First Five Performance Years (2018-2022) - Key Takeaways: *

The Vermont All-Payer Accountable Care Organization (ACO) Model (VTAPM) tests how a state-specific, all-payer ACO program can incentivize broad delivery system transformation to reduce statewide spending and improve population health outcomes. The model was originally scheduled to end in 2022 but has been extended.

This evaluation report focuses on the impact of the model on the Medicare ACO-attributed population—as well as implementation progress and challenges across the state—in its first five performance years (PYs), from 2018 through 2022.

Savings results show statistically significant reductions in both cumulative gross and net Medicare spending for the Medicare ACO, with spending estimates continuing similar trends to those seen throughout the lifecycle of the model. Results are largely driven by reductions in acute care utilization. Report findings also indicate a continuing pattern of increases in primary care evaluation and management (E&M) visits and decreases in specialty care E&M visits, likely reflecting an ongoing shortage of specialists in Vermont which predate the model and have been exacerbated in the years following the Covid-19 PHE.

The VTAPM builds on the state’s history of health reform and parallel reform efforts to drive progress on spending, utilization, and population health goals; as such, results should be interpreted considering these efforts over the last two decades and likely reflect longer-term effects of those efforts, in addition to effects from this model. The model has faced challenges in scaling value-based care due to limited model participation in all three payer ACO initiatives and variation in payment mechanisms across payers. Additionally, financial constraints, administrative burden, and access to timely data have been barriers to population health efforts. Overall, though, there is agreement among stakeholders that the model improved understanding and acceptance of value-based care among providers and inspired collaborative population health initiatives.

*The Two Page Overview:*


* Findings-At-A-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vtapm-4th-eval-report-aag ]

*The Report (includes an Executive Summary):*


* Evaluation of the First Five Performance Years (2018-2022)  (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vtapm-4th-eval-full-report ]
* Go directly to the Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vtapm-4th-eval-full-report#page=7 ]

*Additional Supporting Materials:*


* Appendix: Research Questions, Data, and Methods (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/vtapm-4th-eval-report-app ]
* Model Page: Vermont All-Payer ACO Model [ https://www.cms.gov/priorities/innovation/innovation-models/vermont-all-payer-aco-model ] [ https://www.cms.gov/priorities/innovation/innovation-models/comprehensive-primary-care-plus ]
* Related Model Page: States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model [ https://www.cms.gov/priorities/innovation/innovation-models/ahead ]
VT All Payer ACO Model 4th AR AAG





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Information Hand

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 [ https://innovation.cms.gov/ ],
and follow us on Twitter [ https://twitter.com/CMSinnovates ].









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