January 2020
This newsletter highlights recently released Center for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) evaluation reports and publications. You can access reports by going to the data and reports page of the Innovation Center webpage.
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Reports highlighted in this edition:
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Medicare Prior Authorization Model for Non-Emergent Hyperbaric Oxygen (HBO)
Final Evaluation Report Key Takeaways:
The prior authorization model decreased HBO therapy utilization and quarterly expenditures, but did not have a significant impact on total Medicare expenditures. During the period of model operation examined in the final report, the HBO prior authorization model reduced HBO quarterly expenditures by 32.2 percent, resulting in a reduction of approximately $307 million in HBO service expenditures for beneficiaries with included conditions. The model did not appear to decrease quality of care or increase the probability of adverse events overall.
The Two Page Overview:
The Report (includes an Executive Summary):
Additional Supporting Materials:
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Independence at Home Demonstration (IAH)
Year Four Evaluation Report Key Takeaways:
The two analyses performed yield different results: The demonstration payment incentive is associated with non-significant declines in Medicare expenditures while the care delivery model – home based primary care – is associated with significantly greater expenditures. The different results are not necessarily surprising because of differences in the interventions tested and the samples that are selected. Definitive conclusions on the clinical or policy implications of these findings have not yet been made, but we look forward to examining additional years of the payment incentive structure analysis to assess if observed reductions continue to grow.
The Two Page Overview:
The Report (includes an Executive Summary):
Additional Supporting Materials:
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