Trends in the U.S. Healthcare Industry, Part 2 (continued): CMMI

Our Founder and Principal Consultant, Mike Rawaan, is joined by Backi Baker of Synergy 3C to discuss U.S. Healthcare trends, focusing on the Centers for Medicare and Medicaid Innovation (CMMI).

CMMI and value-based care are among the big open questions in 2025. Thus far CMMI has announced early the termination of four programs by December 2025:

• Primary Care First (PCF)

• Making Care Primary (MCP)

• (Mandatory) ESRD Treatment Choices (ETC)

• Maryland Total Cost of Care (TCOC) models

CMS has also announced that it will not pursue two models announced earlier, which are:

• Medicare $2 Drug List

• Accelerating Clinical Evidence

Finally, CMS intends to reduce the size of the Integrated Care for Kids, but they haven’t mentioned how, so that remains a mystery.

But the bigger mystery is that we have not heard much about new programs and demonstrations.

Many CMMI programs are still active as of Q1, 2025, including:

• ACO Primary Care Flex Model

• ACO REACH

• BPCI Advanced

• Comprehensive Care for Joint Replacement Model (CJR)

• Enhancing Oncology Model

• Expanded Home Health Value-Based Purchasing Model

  
  

Although CMMI has not announced any new programs or demonstrations, there is optimism in Abe Sutton, who has close ties with Adam Boehler, CMMI Director during President Trump’s first term in office, being appointed as CMMI Director. If Mr. Bohler's tenure in CMMI, where he launched 16 new models, is an indication of what we'll see from Abe Sutton, then expect more value-based models.

Key Personnel

• Dr. Mehmet Oz, a former TV celebrity, was appointed as CMS Administrator

• Abe Sutton, Principal at Rubicon Founders, who has close ties with Adam Boehler, CMMI Director during President Trump’s first term in office, was appointed as CMMI Director

• Brad Smith, who also served as CMMI Director during President Trump’s first term in office, has taken a role at HHS