Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments
Appendix: Payments Allocated for CMMI Models
| Table A1: Innovation Center Model Payments, as of September 2014 (From the Centers for Medicare and Medicaid Services’ Report to Congress, December 2014)a |
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Initiative |
CMS Innovation Center payments made to model participants | Payments under Title XVIII or XIX made for services on behalf of beneficiaries | Other CMS Innovation Center funds obligated to support model development and testing |
| Primary Care Transformation | |||
| Comprehensive Primary Care | $172,740,615 | Payments not yet made (expected FY 2015) | $57,609,096 |
| Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) | $45,967,680 | N/A | $22,868,754 |
| Accountable Care Organizations | |||
| Pioneer Accountable Care Organization Model | N/A | $80,719,585 | $87,048,657 |
| Advance Payment Accountable Care Organization Model | $67,801,572b | $5,705,754c | $5,371,781 |
| Comprehensive End-Stage Renal Disease Care Model | N/A | Payments not yet made | $16,476,376d |
| Bundled Payments for Care Improvement | |||
| Bundled Payments for Care Improvement (Models 1-4) | N/A | Data not yet available | $40,399,579 |
| Initiatives Focused on the Medicaid Population | |||
| Strong Start for Mothers and Newborns (Strategies 1 & 2) | $23,594,395 | N/A | $47,649,930 |
| Initiatives Focused on Medicare-Medicaid Enrollees | |||
| State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees | $70,509,361 | N/A | $18,928,906 |
| Financial Alignment Initiative | $5,207,996 | Data not yet available | $79,839,514e |
| Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents | $78,900,786 | N/A | $11,245,590 |
| Initiatives to Speed the Adoption of Best Practices | |||
| Partnership for Patients | N/A | N/A | $451,352,024 |
| Million Hearts® | N/A | N/A | N/A |
| Initiatives to Accelerate New Service Delivery and Payment Model Testing | |||
| Health Care Innovation Awards Round 1 | $879,640,554f | N/A | $60,477,074 |
| Health Care Innovation Awards Round 2 | $120,033,340 | N/A | $7,272,376 |
| State Innovation Models (Round One) | $181,418,835 | N/A | $32,335,764 |
| State Innovation Models (Round Two) | Payments not yet made | N/A | $1,985,982g |
| Medicaid Innovation Accelerator Program | N/A | N/A | Obligations not yet made |
| Maryland All-Payer Model | N/A | N/A | $5,608,084 |
| Medicare Care Choices Model | Payments not yet made | N/A | $1,857,149 |
| Prior Authorization Model: Non-Emergent Hyperbaric Oxygen Therapy | N/A | N/A | Obligations not yet made |
| Prior Authorization Model: Repetitive Scheduled Non-Emergent Ambulance Transport | N/A | N/A | $4,338,941 |
| Subtotals | $1,645,815,124 | $86,425,339 | $952,665,577 |
| SOURCES: – a Table taken from: Table 3 of Centers for Medicare and Medicaid Services, Report to Congress, December 2014, available at https://innovation.cms.gov/Files/reports/RTC-12-2014.pdf. – b Payments made to model participants in the Advance Payment ACO Model represent the advance payments given to ACOs as part of the model, which were distributed under the authority of section 1115A of the Social Security Act. – c Payments made to model participants in the Advance Payment ACO Model under Title XVIII or XIX were distributed as shared savings payments under the authority of the Medicare Shared Savings Program. – d Of this amount, $1,321,039 was obligated as application support through the FY2013 pre-implementation budget. – e Of this amount, $1,495,660 was obligated for the Financial Alignment Initiative under the FY2011 budget for the State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees. – f This total reflects the full amount of grant funding provided to HCIA awardees for the 3-year period of performance. Funds are used by awardees to implement models, including payments to providers of services, and to suppliers. – g This funding was used for the Medicaid Innovation Accelerator Program (IAP) Learning Collaborative in FY2014. The IAP program is budgeted separately in FY2015 and thereafter. |
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