CMS Innovation Center

CMS Innovation Center
Name	CMS Innovation Center
Formation	2010
Founder	Kathleen Sebelius
Type	Federal agency initiative
Headquarters	Baltimore
Leader title	Director
Leader name	Patrick Conway
Parent organization	Centers for Medicare & Medicaid Services

Contents

CMS Innovation Center The CMS Innovation Center is a federal initiative established to test payment and service delivery models for Medicare (United States), Medicaid, and the Children's Health Insurance Program. It was created under the Patient Protection and Affordable Care Act to align incentives across healthcare providers such as hospitals, physicians, and nursing homes while engaging payers, accountable care organizations, and community health centers. The Center collaborates with stakeholders including Centers for Medicare & Medicaid Services, Department of Health and Human Services, and private entities like UnitedHealth Group and Aetna.

History and Establishment

The Center was authorized by Section 3021 of the Patient Protection and Affordable Care Act and announced during the tenure of Kathleen Sebelius as Secretary of Department of Health and Human Services. Early leadership included Donald Berwick and later directors such as Patrick Conway, with formative partnerships involving The Commonwealth Fund, Robert Wood Johnson Foundation, and Kaiser Permanente. Initial pilot models drew on prior demonstrations from Demonstration projects (Medicare), Medicaid managed care, and initiatives like Health and Human Services Innovation Projects. The Center built on lessons from Geisinger Health System, Mayo Clinic, Cleveland Clinic, and international examples such as NHS England and Canadian Medicare (Alberta). Key legislative and regulatory milestones involved rulemaking at Federal Register and oversight from Congressional Budget Office and Government Accountability Office reviews.

The Center's stated mission is to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for beneficiaries of Medicare (United States), Medicaid, and the Children's Health Insurance Program. Objectives include promoting value-based payment across accountable care organizations, shifting volume-based incentives toward outcomes as exemplified by models used at Intermountain Healthcare and Johns Hopkins Hospital, reducing hospital readmissions like targeted by the Hospital Readmissions Reduction Program, and improving chronic disease management strategies used by Centers for Disease Control and Prevention initiatives. It aims to foster collaboration with state Medicaid agencies, Tribal Nations, and organizations such as AARP and American Hospital Association.

Notable programs include the Accountable Care Organization models, the Bundled Payments for Care Improvement initiative, the Comprehensive Primary Care Plus model, the Medicare Shared Savings Program, the Next Generation ACO Model, and the Comprehensive End-Stage Renal Disease Care Model. Other models span the Hospital Readmissions Reduction Program adaptations, the Transforming Clinical Practice Initiative, and the Independence at Home Demonstration. Demonstrations addressing behavioral health integrated models worked with Substance Abuse and Mental Health Services Administration partners. Pilot collaborations engaged private-sector partners such as Aetna, Humana, Blue Cross Blue Shield, Cigna, Optum, and provider networks like Partners HealthCare and Mount Sinai Health System. International comparisons included models from Singapore Health Services and Beveridge model systems in United Kingdom contexts like NHS England.

Evaluations have been conducted by entities including the Agency for Healthcare Research and Quality, RAND Corporation, Urban Institute, Mathematica Policy Research, Harvard T.H. Chan School of Public Health, and Johns Hopkins Bloomberg School of Public Health. Findings reported impacts on spending trends, quality metrics, hospital readmissions (compared to Hospital Readmissions Reduction Program benchmarks), and care coordination outcomes. The Congressional Budget Office and Government Accountability Office produced analyses of budgetary effects, while peer-reviewed literature in journals such as New England Journal of Medicine and Health Affairs assessed methodological rigor. Some models demonstrated reductions in total cost of care in partnership with systems like Geisinger Health System and Intermountain Healthcare, while others showed mixed results similar to evaluations of Medicaid waiver experiments in states like California, Texas, and Massachusetts.

The Center operates within Centers for Medicare & Medicaid Services under the Department of Health and Human Services and follows appropriations and authorities set by Congress of the United States. Funding mechanisms have included direct appropriations, reallocated Medicare trust funds authority, and model-specific budgets reviewed by the Congressional Budget Office. Oversight and reporting obligations have involved Office of Management and Budget, Office of Inspector General (United States Department of Health and Human Services), and hearings before committees such as the United States Senate Committee on Finance and the United States House Committee on Ways and Means. Partnerships and grants engaged philanthropic entities like The Commonwealth Fund and Robert Wood Johnson Foundation and contractors including Deloitte, McKinsey & Company, and Accenture for implementation support.

Critiques have arisen from American Medical Association, American Hospital Association, AARP, and scholars at Brookings Institution and Urban Institute regarding measurement, risk adjustment, and potential unintended consequences such as patient selection and access disparities documented in studies published in JAMA and Health Affairs. Legal challenges referenced authorities under the Patient Protection and Affordable Care Act and raised questions adjudicated in courts including United States District Court for the District of Columbia and considered by appeals panels. Concerns about private-sector contractors and potential conflicts have been raised in investigations by the Government Accountability Office and Office of Inspector General (United States Department of Health and Human Services). Debates continue among policymakers from Republican Party (United States) and Democratic Party (United States) factions over scope, scale, and federalism implications involving state Medicaid agencies and Tribal Nations.