びびなび : ワシントンDC : (アメリカ合衆国) Washington DC

header




CMS Innovation Center Evaluation Digest




*December 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:*


* Accountable Health Communities (AHC) Model
* Oncology Care Model (OCM)
* Comprehensive Joint Replacement (CJR) Model





________________________________________________________________________



Accountable Health Communities (AHC) Model

*Third Evaluation Report (2018-2023)- Key Takeaways:*

The Accountable Health Communities (AHC) Model tested whether connecting beneficiaries to community resources for their health-related social needs (HRSNs) improved health care utilization outcomes and reduced costs. The model screened all fee-for-service (FFS) Medicare and Medicaid beneficiaries for core HRSNs in two tracks:


* *Assistance Track*: Eligible beneficiaries were randomly assigned to receive navigation (intervention group) or referral only (control group).
* *Alignment Track*: All eligible beneficiaries were offered navigation and received care from organizations that engaged with model stakeholders in continuous quality improvement to align community resources with beneficiaries’ HRSNs.

The AHC Model was associated with reduced total expenditures and improved quality of care, even though the model resulted in moderate increases in beneficiaries’ connection to community services and HRSN resolution overall. Some populations—such as those in underserved racial and ethnic populations—were more likely to have their needs resolved. The model was also associated with more-pronounced health care impacts for these same subpopulations. One possible explanation for these findings is that navigators not only helped beneficiaries with HRSNs but also addressed tangible barriers to health care (e.g., transportation to appointments) and helped them navigate the health care system generally. Collectively, these findings provide evidence that navigation can transform the delivery of care in ways that address major HRSN barriers to health and promote health equity for underserved populations.

*The Two Page Overview:*


* Findings At-a-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ahc-3rd-eval-report-aag ]

*The Report (includes an Executive Summary):*


* Third Evaluation Report (2018 - 2023) (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ahc-3rd-eval-report ]
* The Executive Summary begins on page 13

*Additional Supporting Materials:*


* Appendix: Methods and Supplemental Analyses (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ahc-3rd-eval-report-apps ]
* Model Page: Accountable Health Communities Model [ https://www.cms.gov/priorities/innovation/innovation-models/ahcm ]
AHC At-a-Glance Cover thumbnail image

________________________________________________________________________



Oncology Care Model (OCM)

*Third Evaluation Report (2018-2023) - Key Takeaways:*

OCM was a voluntary model that tested whether financial incentives could improve quality and reduce Medicare spending. The model launched on July 1, 2016, and ended June 30, 2022. It focused on Medicare fee-for-service (FFS) beneficiaries with cancer undergoing chemotherapy treatment.

This report is a supplemental report that focuses on the impacts of participants based on their risk-arrangement.

Practices that participated in two-sided risk in the latter half of the model were the main driver of overall model payment reductions. This report analyzes the impacts of participants by their adopted risk-arrangement (e.g., one-sided or two-sided). Practices that adopted two-sided risk by the end of the model were the only group that succeeded in reducing total episode payments.

These practices performed well early in the model, which may have informed their decision to select into two-sided risk. But they also continued to improve their performance after adoption of two-sided risk. These two-sided risk practices were more likely than other OCM practices to implement care transformation processes such as routinely initiating proactive outreach telephone calls to high-risk patients. The depth and breadth of the care transformation work undertaken by these practices signals a strong level of commitment and effort of these practices in carrying out the aims of the model.

*The Report (includes an Executive Summary):*


* Supplemental Report: Impacts by Risk Arrangement (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-tot-report ]
* The Executive Summary begins on page 4

*Additional Supporting Materials:*


* Appendix: Supplemental Analyses - begins on page 38
* Model Page: Oncology Care Model (OCM) [ https://www.cms.gov/priorities/innovation/innovation-models/oncology-care ]
* Related Model Page: Enhancing Oncology Model (EOM) [ https://www.cms.gov/priorities/innovation/innovation-models/enhancing-oncology-model ]
OCM Eval Report Cover thumbnail image

________________________________________________________________________



Comprehensive Joint Replacement (CJR) Model

*Evaluation of Performance Year 6 - Key Takeaways:*

The CJR model launched on April 1, 2016, to test whether an episode-based payment model for Lower Extremity Joint Replacements (LEJRs) can lower payments while maintaining or improving quality.

In Performance Year 6, CJR hospitals continued to optimize post-acute care use, achieve value, improve patient satisfaction, and widen access to LEJRs.

Some selected key takeaways were:


* CJR hospitals reduced facility-based post-acute care use, which drove reductions in LEJR episode payments.
* The model generated statistically significant Medicare savings of $54.2M in Performance Year 6, mainly driven by reductions in episode payments and, to a smaller extent, repayments from hospitals which exceeded payouts from CMS.
* CJR hospitals maintained quality for LEJR patients.
Hospitals associated with a Medicare Accountable Care Organization (ACO) leveraged the aligned incentives between CJR and ACOs to transform care.  

The Drivers of Impact Report [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-drivers-impact ] (30 pages) presents the story of the Comprehensive Care for Joint Replacement (CJR) Model as a prime example of a value-based care model that spurs innovative approaches to care delivery.

The [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-drivers-transformation ]Drivers of Transformation Report [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-drivers-transformation ](35 page) explores how and why CJR hospitals transformed care for patients receiving hip, knee, and ankle replacement surgery.

The In-Depth Report [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-annual-report ] (100 pages) provides a comprehensive presentation of evaluation findings and methodology.

*The Two Page Overview:*


* Findings-At-A-Glance (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-findings-aag ]

*The Report:*


* Evaluation of Performance Year 6: Drivers of Impact Report (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-drivers-impact ]
* Executive Summary (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-exec-sum ]

*Additional Supporting Materials:*


* Drivers of Care Transformation: How and Why CJR Transformed Care (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-ar-drivers-transformation ]
* In-Depth Report: Comprehensive Evaluation Findings for Performance Year 6 (PDF) [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/cjr-py6-annual-report ]
* Appendix: Methods and Supplemental Analyses - begins on page 123 of the In-Depth Report
* Model Page: Comprehensive Care for Joint Replacement (CJR) Model [ https://www.cms.gov/priorities/innovation/innovation-models/cjr ]
* Related Model Page: Transforming Episode Accountability Model (TEAM) [ https://www.cms.gov/priorities/innovation/innovation-models/team-model ]
CJR Eval Report Cover thumbnail image





________________________________________________________________________



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 ].









________________________________________________________________________

You're getting this message because you subscribed to get email updates from the Centers for Medicare & Medicaid Services (CMS) [ http://www.cms.gov/ ].

Update your subscriptions, modify your password or email address, or stop subscriptions at any time on your Subscriber Preferences Page [ https://public.govdelivery.com/accounts/USCMS/subscriber/edit?preferences=true#tab1 ]. You will need to use your email address to log in. If you have questions or problems with the subscription service, please contact subscriberhelp.govdelivery.com [ https://subscriberhelp.govdelivery.com/ ].

This service is provided to you at no charge by Centers for Medicare & Medicaid Services (CMS) [ http://www.cms.gov ].


________________________________________________________________________

This email was sent to mshinji3056@gmail.com using GovDelivery Communications Cloud 7500 Security Boulevard · Baltimore MD 21244


body .abe-column-block { min-height: 5px; } table.gd_combo_table img {margin-left:10px; margin-right:10px;} table.gd_combo_table div.govd_image_display img, table.gd_combo_table td.gd_combo_image_cell img {margin-left:0px; margin-right:0px;} table.govd_hr {min-width: 100%;}