What the End of Four CMMI Payment Models Means for Healthcare Providers 

The Center for Medicare and Medicaid Innovation (CMMI) has announced the early termination of four payment models by the end of the year in an effort to save $750 million. These changes, while intended to streamline costs and improve efficiency, will undoubtedly have an impact on healthcare providers who have been participating in these models. 

Which Models Are Ending and Why It Matters 

The four models that will be discontinued as of December 31 are: 

• Maryland Total Cost of Care 

• Primary Care First 

• ESRD Treatment Choices 

• Making Care Primary 

Additionally, CMS is considering adjustments to the Integrated Care for Kids model, which could include reducing the size of the awards or making other changes. Furthermore, the agency has decided not to pursue two previously announced models, Medicare $2 Drug List and Accelerating Clinical Evidence. 

CMMI has stated that these decisions were made after conducting a comprehensive, data-driven review based on the statutory mandate given to the Center by Congress. The agency emphasizes that it aims to minimize disruptions for patients currently enrolled in these models while shifting its focus toward new strategies. 

The Immediate Impact on Healthcare Providers 

For providers who have relied on these models, the transition could be challenging. Many healthcare organizations have integrated the payment structures and care strategies associated with these models into their daily operations. Ending these models may require: 

• Administrative adjustments to realign billing and reimbursement practices. 

• New care coordination strategies to maintain quality patient outcomes. 

• Financial restructuring to accommodate potential revenue losses from incentive-driven models. 

Providers who have invested in training staff and developing workflows around these models may feel the most significant impact. With the abrupt end to Primary Care First, for example, many independent primary care providers who benefited from simplified reimbursement structures will now need to revert to traditional fee-for-service models or explore alternative value-based care arrangements. 

The Bigger Picture: What This Signals for Future Payment Models 

CMMI has indicated that its future strategy will center around preventing disease through evidence-based practices while empowering patients with information to make better healthcare choices. While details remain sparse, this could mean an increased emphasis on: 

• Preventative care incentives that shift reimbursement towards early interventions. 

• Data-driven quality measures that reward providers for proven patient outcomes. 

• Greater competition among providers to drive down costs while improving care. 

At the heart of this shift is the goal of streamlining CMMI’s models, ensuring that future programs align more closely with budgetary constraints and long-term health policy objectives. 

Political and Policy Context: A Move Toward Cost-Saving Measures 

The termination of these models is part of a broader trend within the federal government aimed at reducing spending in Medicare and Medicaid programs. House Republicans have proposed significant budget cuts, including a potential $880 billion reduction in spending on healthcare programs overseen by the House Committee on Energy and Commerce. 

In addition to CMMI’s changes, the government has also: 

• Slashed funding for the Affordable Care Act Navigator Program from $98 million in 2024 to just $10 million. 

• Proposed cuts to Medicaid, as outlined by the Congressional Budget Office’s projections. 

• Reduced federal support for diversity, equity, and inclusion (DEI) programs. 

• Laid off employees from federal health agencies, including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). 

For healthcare providers, this means less federal funding for pilot programs and experimental care models, signaling a shift towards more traditional and cost-effective approaches to care delivery. 

How Providers Can Prepare 

With these changes on the horizon, healthcare providers must take proactive steps to navigate the shifting landscape. Some key actions to consider include: 

1. Assessing Financial Impact 

Providers should evaluate how the termination of these models will affect their revenue streams and plan accordingly. For organizations heavily reliant on value-based incentives, exploring new reimbursement structures is critical. 

2. Exploring Alternative Payment Models 

While some models are ending, others remain in place or may be introduced in the future. Providers should stay informed about new opportunities for value-based reimbursement and consider joining alternative models that align with their practice goals. 

3. Enhancing Preventative Care Initiatives 

Given CMMI’s focus on prevention, investing in wellness programs and preventative services may provide long-term benefits. This could include integrating screening programs, chronic disease management, and patient education into standard practice. 

4. Advocating for Policy Changes 

Providers should engage with industry associations, policymakers, and advocacy groups to ensure their voices are heard. Collaboration with organizations such as the American Medical Association (AMA) and the Medical Group Management Association (MGMA) can help shape future policies that better support healthcare professionals. 

5. Strengthening Revenue Cycle Management 

With reimbursement structures in flux, optimizing billing, coding, and revenue cycle management (RCM) is crucial. Partnering with a reliable billing service or investing in more efficient internal billing processes can help mitigate financial disruptions. 

What’s Next for CMMI and Providers? 

While the decision to end these four payment models may seem sudden, it reflects a broader strategy to refine and refocus CMMI’s initiatives. Providers should anticipate more changes in the coming years as the agency continues its efforts to streamline costs and shift towards a more sustainable healthcare model. 

For now, the best approach for providers is to remain adaptable, informed, and proactive in navigating these evolving policies. By focusing on financial resilience, preventative care, and strategic advocacy, healthcare organizations can position themselves for success in an uncertain regulatory landscape. 

These changes are complex, and their full impact will unfold over time.