A Government Accountability Office audit of the Center for Medicare and Medicaid Innovation’s historic spending and the results of its models has reignited calls from lawmakers for increased oversight of its activities.
The report, prompted by a 2024 request from House Budget Committee leaders and released last week, outlined 70 delivery and payment models developed and tested by CMMI between 2011 and 2024.
As of January 2025, 24 of them are in active testing, and only four have been scaled up for national implementation, although GAO noted that some elements of these models have been incorporated into Medicare, and iterative successor models are also being tested.
Additionally, the audit outlined a total of $11.4 billion in obligations to CMMI over that 14-year period, with obligations peaking at $1.3 billion in fiscal year 2015 and decreasing to $789 million in fiscal year 2024. CMMI attributed the decline to a reduction in the number of models being tested and, to a lesser extent, changes in how some of the center’s activities are tracked and reported.
“According to stakeholders, the Innovation Center in particular has centralized features in a common model to improve cost efficiency,” GAO wrote in the report. “For example, the agency noted that it has created centralized resources to support specific activities such as information technology and the development of quality standards, and simplified contract management.”
CMMI was established under the Affordable Care Act of 2010, which required the center to spend $10 billion per 10 years to reduce federal health spending and pursue quality improvements.
A new audit report on the four nationally scaled models adds fuel to the fire of CMMI critics, whose calls for reform are thwarted by a 2023 Congressional Budget Office (CBO) assessment that found CMMI increased indirect spending by $5.4 billion in its first 10 years (0.1% of net Medicare spending during that period). CBO initially predicted that CMMI would result in savings, and in subsequent projections, the center estimated it would increase federal spending by $1.3 billion from fiscal year 2021 to fiscal year 2030.
Rep. Jody Arrington (R-Texas), chair of the House Budget Committee, said in a statement this week that CMMI is failing on both quality and savings fronts.
“The success rate (5.7%) is failure, not innovation,” he said. “And with the national debt exceeding $39 trillion, we cannot afford to pay for programs that promise savings but consistently fall short.”
Arrington said the center’s mission is “too important to abandon” and that the effort would be better carried out under the Trump administration.
“I am encouraged by Secretary Kennedy and CMS Administrator Oz’s commitment to rooting out waste, fraud, and abuse and ensuring that the Center for Innovation ultimately fulfills its promise to patients and taxpayers.”
The new administration’s early days brought sweeping changes to CMMI, with officials pledging a “data-driven review” of all current models and premature conclusions on some by the end of 2025, promising cost savings of hundreds of millions of dollars. Among the new pilot programs the company has launched since then is the Medicare Advanced Chronic Care with Effective and Scalable Solutions (ACCESS) model, which promotes the use of new technologies to treat chronic diseases. Wasted and Inappropriate Services Reduction (WISeR) Model. It will introduce prior authorization to traditional Medicare using technology whose details have not yet been disclosed. International prices would then be factored into the inflation rebates that drug manufacturers must pay to Medicare Parts B and D for certain products.
