Innovation Models

The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS. These research and demonstration projects are exempt from the Common Rule under 45 CFR 46.104(d)(5). For additional guidance, refer to the OHRP Revised Common Rule Q&As on Exemptions.

The Innovation Center also plays a critical role in implementing the Quality Payment Program, which Congress created as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In fall 2021, the CMS Innovation Center set a strategic goal for its next ten years: to transform the health system into one that achieves equitable outcomes through high quality, affordable, person-centered care. As part of this, the Center is committed to designing models that are inclusive of a variety of providers who care for underserved populations, ultimately increasing beneficiaries’ access to high-quality care. Learn more.

Our Innovation Models are organized into seven categories.

Categories

  • Accountable Care

    Accountable Care Organizations and similar care models are designed to incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.

  • Episode-based Payment Initiatives

    Under these models, health care providers are held accountable for the cost and quality of care beneficiaries receive during an episode of care, which usually begins with a triggering health care event (such as a hospitalization or chemotherapy administration) and extends for a limited period of time thereafter.

  • Primary Care Transformation

    Primary care providers are a key point of contact for patients' health care needs. Strengthening and increasing access to primary care is critical to promoting health and reducing overall health care costs. Advanced primary care practices - also called "medical homes" - utilize a team-based approach, while emphasizing prevention, health information technology, care coordination, and shared decision making among patients and their providers.

  • Initiatives Focused on the Medicaid and CHIP Population

    Medicaid and the Children's Health Insurance Program (CHIP) are administered by the states but are jointly funded by the federal government and states. Initiatives in this category are administered by the participating states.

  • Initiatives Focused on the Medicare-Medicaid Enrollees

    The Medicare and Medicaid programs were designed with distinct purposes. Individuals enrolled in both Medicare and Medicaid (the "dual eligibles") account for a disproportionate share of the programs' expenditures. A fully integrated, person-centered system of care that ensures that all their needs are met could better serve this population in a high quality, cost effective manner.

  • Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

    Many innovations necessary to improve the health care system will come from local communities and health care leaders from across the entire country. By partnering with these local and regional stakeholders, CMS can help accelerate the testing of models today that may be the next breakthrough tomorrow.

  • Initiatives to Speed the Adoption of Best Practices

    Recent studies indicate that it takes nearly 17 years on average before best practices - backed by research - are incorporated into widespread clinical practice - and even then the application of the knowledge is very uneven. The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption.