Four experimental Medicare payment models will shut down by the end of 2025, at least a year earlier than anticipated, the Centers for Medicare and Medicaid Services announced Wednesday.
The Center for Medicare and Medicaid Innovation is pulling the plug on Primary Care First, Making Care Primary, End-Stage Renal Disease Treatment Choices and Maryland Total Cost of Care, and seeks to scale back the Integrated Care for Kids model in Medicaid and the Children's Health Insurance Program, CMS said in a pair of news releases.
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"As is the nature of innovation, not every model will work, and the center must be efficient and effective in its response," CMS said in a news release.
The agency instead will roll out a new plan that appears to align with Health and Human Services Secretary Robert F. Kennedy Jr.’s stated interest in chronic disease.
"The Innovation Center plans to announce a new strategy based on guiding principles to make Americans healthier by preventing disease through evidence-based practices, empowering people with information to make better decisions, and driving choice and competition," CMS said in a news release.
Conservatives on Capitol Hill and elsewhere have long expressed skepticism about the value of CMMI's various payment models, citing uneven budgetary and clinical results. The Heritage Foundation’s Project 2025 playbook for President Donald Trump's administration, for instance, recommends canceling the Medicare Shared Savings Program accountable care organization model.
The ACO Realizing Equity, Access and Community Health, or ACO REACH, model and Transforming Episode Accountability Model, or TEAM — which are scheduled to sunset at the end of 2026 — and the Medicare Shared Savings Program are not affected by the cancellations. CMS declined to comment on the future of the Medicare Shared Savings Program or ACO REACH.
Participants in the models being wound down may transition to other models by Dec. 31, CMS said in a news release. "Ending these models early offers the opportunity to get beneficiaries into more permanent programs to support their health and care," the agency said.
- The voluntary Primary Care First model, which began in 2021 and was slated to run through 2026, was designed to improve advanced primary care delivery, particularly for patients who do not regularly see primary care providers.
- The Making Care Primary model was meant to improve coordination and care management between primary care providers, specialists and community resources. The model started last year and was meant to run through 2034.
- The mandatory ESRD Treatment Choices Model was intended to improve home dialysis uptake and improve the kidney transplant process while reducing spending. CMS will have to issue a regulation to discontinue this model, which debuted in 2020 and was scheduled to last through 2027.
- The Maryland Total Cost of Care model makes the state fully responsible for Medicare costs and builds on Maryland's all-payer rate-setting system.
- The Integrated Care for Kids model, or InCK, is designed to help providers identify children with complex health needs and tailor treatment programs and interventions for them. CMS introduced the initiative in 2019 and it is slated to operate through 2026.
"Primary care remains a foundational component of the center’s strategy," CMS said in a news release. "The early termination of Primary Care First and Making Care Primary does not signal a retreat from the center’s support of primary care providers, but rather a need to focus on different approaches that are consistent with the CMS innovation center’s statutory mandate and produce savings."
CMMI is also scrapping plans for two drug pricing models announced in 2023 but not implemented. The Medicare $2 Drug List proposal would have promoted cheaper generic medicines in Medicare Part D, while the Accelerating Clinical Evidence would have allowed for lower Part B payments for medications approved under expedited Food and Drug Administration reviews.
