By Brevy Care Team

The CMS Innovation Center — formally the Center for Medicare and Medicaid Innovation, universally abbreviated CMMI — is the federal laboratory for Medicare and Medicaid payment and care delivery innovation. Established by the Patient Protection and Affordable Care Act of 2010, equipped with $10 billion of appropriated funding per 10-year period, and granted the unique authority to expand successful models without further rulemaking, CMMI has fundamentally reshaped Medicare since 2010. For every Georgia clinician participating in the MSSP, ACO REACH, Primary Care First, Kidney Care Choices, or Enhancing Oncology Model — and for every Atlanta MSA hospital operating under the mandatory Comprehensive Care for Joint Replacement (CJR) bundle — CMMI is the source of the modern value-based-care framework that defines Medicare today.

The statutory foundation: Section 1115A and ACA Section 3021

CMMI was created by Section 3021 of the Patient Protection and Affordable Care Act (Public Law 111-148, March 23, 2010), which added Section 1115A to the Social Security Act (42 U.S.C. § 1315a). The statutory framework has several distinctive features:

Funding (Section 1115A(f))

  • $10 billion appropriated per 10-year period (i.e., approximately $1 billion per year)
  • Permanent appropriation — not subject to annual congressional appropriations
  • Funds available without further appropriation action
  • Among the largest standing federal innovation appropriations in healthcare

Mandate (Section 1115A(a))

  • Test innovative payment and service delivery models
  • Reduce Medicare/Medicaid/CHIP program expenditures
  • Preserve or enhance quality of care
  • Address populations with greatest opportunity for cost and quality improvement

Model definitions (Section 1115A(b))

  • "Model" means a payment or service delivery model
  • Models can be national or regional
  • Models can target specific provider types, beneficiary populations, conditions, or care delivery settings
  • Models can be voluntary or mandatory (with appropriate authority)

Evaluation and expansion (Section 1115A(c) — the certification authority)

The CMMI's most distinctive statutory feature is the certification and expansion authority under Section 1115A(c):

  • HHS Secretary may expand a model (in duration and scope) through rulemaking if the Office of the Actuary and the Secretary determine that:
    • The model reduces Medicare/Medicaid program expenditures without reducing quality, OR
    • The model improves quality without increasing expenditures
  • This authority allows nationwide expansion of successful pilot models without separate congressional action
  • Used to expand the Pioneer ACO Model (later the MSSP) — a unique federal power

Reporting (Section 1115A(g))

  • Biennial reports to Congress on CMMI activities
  • Annual public progress reports
  • Independent evaluation requirements

CMMI implementing regulations are scattered across model-specific regulations rather than a single comprehensive subpart, reflecting the model-by-model architecture of CMMI's work.

The CMMI October 2021 Strategy Refresh

In October 2021, CMMI published a Strategy Refresh centering three strategic goals:

1. Accountable Care

  • Move all Medicare beneficiaries to an accountable care relationship by 2030
  • Expand MSSP, ACO REACH, and primary care accountability models
  • Build infrastructure for population-based payment

2. Health Care Quality

  • Improve clinical quality outcomes
  • Improve patient-reported outcomes
  • Align quality measurement across CMMI models with MIPS and MSSP

3. Health Equity

  • Embed Health Equity Plans in CMMI models (e.g., ACO REACH mandates)
  • Use Area Deprivation Index (ADI) and similar tools to direct resources to underserved populations
  • Track and report disparities by race, ethnicity, and other demographic dimensions

The Strategy Refresh shapes CMMI's model design and selection going forward, with new models required to demonstrate alignment with all three goals.

The CMMI model portfolio

CMMI's portfolio spans dozens of historical and current models across multiple categories. Major models include:

Accountable Care Organizations

  • Medicare Shared Savings Program (MSSP) — Section 1899 SSA (separate statutory framework from CMMI but administered alongside; the MSSP and CMMI evolved together). BASIC Levels A-E and ENHANCED. The foundational ACO model.
  • ACO REACH (Accountable Care Organization Realizing Equity, Access, and Community Health) — 2023-2026. Replaced Direct Contracting (GPDC). Professional and Global tracks. Mandatory Health Equity Plan. 75% provider governance. Standard, New Entrant, and High Needs Population types.
  • Pioneer ACO Model — predecessor, ended 2016 (lessons feeding MSSP and ACO REACH).
  • Next Generation ACO Model — predecessor, ended 2021 (lessons feeding ACO REACH).

Primary Care Models

  • Primary Care First (PCF) — capitated primary care with quality and outcomes incentives. Advanced APM.
  • Comprehensive Primary Care Plus (CPC+) — predecessor, ended 2021 (lessons feeding PCF).
  • Comprehensive Primary Care (CPC) — earlier predecessor.
  • Making Care Primary (MCP) — launched 2024 in selected states (Georgia not in first wave). Three-track design. Multi-year care transformation model.

Specialty Models

  • Kidney Care Choices (KCC) — value-based kidney care including Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC). Advanced APM.
  • Enhancing Oncology Model (EOM) — replaced Oncology Care Model (OCM). Five-year episode-based oncology payment.
  • Oncology Care Model (OCM) — predecessor, ended June 2022.
  • Radiation Oncology Model (RO Model) — episode-based radiation oncology payment.
  • Comprehensive ESRD Care (CEC) — predecessor.

Episode-Based Bundled Payment Models

  • Bundled Payments for Care Improvement Advanced (BPCI Advanced) — voluntary episode-based bundles across surgical and medical episodes. Advanced APM.
  • Comprehensive Care for Joint Replacement (CJR) Model — mandatory model for hip and knee arthroplasty bundles in selected metropolitan statistical areas (MSAs). Atlanta MSA is a CJR participating MSA. Hospitals in CJR MSAs are required to participate.
  • Episode Payment Models — predecessor specialty bundles (cardiac care, surgical hip/femur fracture treatment), ended.

State-Based Models

  • Maryland Total Cost of Care (MD TCOC) Model — statewide total cost of care framework for Maryland.
  • State Innovation Models (SIM) — state-led testing and implementation of payment and delivery reforms.
  • AHEAD Model (States Advancing All-Payer Health Equity Approaches and Development) — multi-payer global budget framework.
  • Financial Alignment Initiative (FAI) — testing integration of Medicare and Medicaid for dually-eligible beneficiaries.
  • Medicare-Medicaid Integration models — various state demonstrations.

Behavioral Health

  • Innovation in Behavioral Health (IBH) Model — emerging integration of behavioral health into primary care.
  • Various other behavioral health pilots

Quality and Care Delivery Innovations

  • Million Hearts Cardiovascular Disease Risk Reduction Model — population-health-focused cardiovascular risk model.
  • Home Health Value-Based Purchasing (HHVBP) — value-based purchasing for home health agencies (expanded nationally per Section 1115A(c)).
  • Skilled Nursing Facility Value-Based Purchasing (SNF VBP) — value-based purchasing for SNFs.

How CMMI tests, evaluates, and expands models

Stage 1: Model concept

  • CMMI identifies a payment or service delivery innovation opportunity
  • Stakeholder engagement (provider associations, beneficiary advocates, state Medicaid agencies, payer organizations)
  • Conceptual design and statutory authority review
  • Release of Request for Applications (RFA) or model design document

Stage 2: Model testing

  • Participant recruitment (often via competitive application)
  • Model launch with defined performance period (typically 4-6 years)
  • Mid-cycle adjustments per CMMI rule-making authority
  • Quality monitoring and operational support

Stage 3: Evaluation

  • Independent contractors evaluate the model under Section 1115A(b)(4) and (g)(1)
  • Common evaluators: RTI International, Mathematica Policy Research, Abt Associates, The Urban Institute, Lewin Group, NORC at the University of Chicago, Mathematica's Center for Improving Value in Health Care
  • Methodologies: difference-in-differences, propensity-score matching, regression discontinuity, mixed-methods qualitative analysis
  • Annual evaluation reports published publicly

Stage 4: Certification and expansion (Section 1115A(c))

  • HHS Secretary and CMS Office of the Actuary jointly determine whether the model meets the dual standard:
    • Reduces program expenditures without reducing quality, OR
    • Improves quality without increasing expenditures
  • If certified, the Secretary may expand the model nationwide via rulemaking
  • If not certified, the model typically ends at its scheduled performance period close

Notable models that have been certified for expansion under Section 1115A(c):

  • Pioneer ACO Model → MSSP enhancements
  • Home Health Value-Based Purchasing (HHVBP) → nationwide expansion
  • Selected payment innovations within ACO programs

CMMI and the Quality Payment Program

CMMI models are central to the Quality Payment Program (QPP) established by MACRA 2015. Most current Advanced APMs producing Qualifying APM Participant (QP) status are CMMI models:

  • MSSP BASIC C/D/E (Section 1899, not CMMI, but operationally aligned)
  • MSSP ENHANCED (Section 1899)
  • ACO REACH Professional and Global (CMMI)
  • Primary Care First (PCF) (CMMI)
  • Kidney Care Choices (KCC) (CMMI)
  • Making Care Primary (MCP) (CMMI)
  • BPCI Advanced (CMMI)

Each Advanced APM:

  • Provides QP status to participating clinicians meeting thresholds
  • Exempts QPs from MIPS
  • Historically provided the 5% APM Incentive Payment (PY 2017-2022) or 3.5% (PY 2023, CAA 2023)
  • Beginning PY 2024 (Payment Year 2026) provides the Qualifying APM Conversion Factor differential

CMMI's model design choices directly shape Medicare clinician value-based-care opportunities.

Comprehensive Care for Joint Replacement (CJR) and the Atlanta MSA

CJR deserves particular Georgia attention. CJR is one of the few mandatory CMMI models — hospitals in CJR-participating Metropolitan Statistical Areas are required to participate (subject to certain volume exclusions).

CJR overview

  • Episode: 90 days following hospital discharge for lower-extremity joint replacement (DRG 469 and 470)
  • Bundle: All Medicare Part A and Part B services within the episode
  • Reconciliation: Compare actual episode spend to a target price; hospital owes Medicare (if over target) or receives savings (if under)
  • Quality: Performance on Hip/Knee Complications, Patient Experience (HCAHPS), and Voluntary THA/TKA PRO measures affects target price calculations

Atlanta MSA participation

  • Atlanta MSA hospitals are among the original CJR-participating regions (since model launch April 1, 2016)
  • Major Atlanta MSA hospitals participate: Wellstar facilities, Emory facilities, Piedmont facilities, Northside facilities (subject to volume and exclusions)
  • Hospitals coordinate with skilled nursing facilities, home health agencies, and outpatient rehabilitation providers to manage post-discharge episode costs

CJR extensions

  • CJR was extended multiple times beyond its original three-year period
  • Currently extended through CY 2024 per most recent CMMI rulemaking
  • Some Georgia hospitals approach CJR with sophisticated bundled care management; others struggle with post-acute coordination

ACO REACH and the CMMI Health Equity priority

ACO REACH (launched January 1, 2023, through December 31, 2026) is the flagship implementation of the CMMI October 2021 Strategy Refresh's Health Equity priority. Key Health Equity features:

  • Mandatory Health Equity Plan — Every ACO REACH ACO must adopt and operationalize a Health Equity Plan
  • 75% provider governance — At least 75% of ACO board control must be in the hands of participating providers
  • Health Equity Benchmark Adjustment — Adjusts ACO benchmarks based on Area Deprivation Index (ADI) and dual-eligible enrollment, providing more favorable financial benchmarks to ACOs serving underserved populations
  • Disparities reporting — ACOs must track and report quality and outcomes disparities by demographic characteristics

For Georgia, ACO REACH operations include:

  • Northside Hospital ACO REACH (selected track)
  • Other Georgia integrated systems participating in or considering ACO REACH

Georgia provider participation

Wellstar Health System

  • MSSP participation (track-dependent for QP/Advanced APM status)
  • Atlanta MSA CJR participation for hip/knee replacement bundles
  • Various other CMMI models under evaluation/consideration

Emory Healthcare Network

  • Emory CIN ACO in MSSP ENHANCED (Advanced APM)
  • Atlanta MSA CJR participation
  • Selected oncology model participation (EOM)

Piedmont Healthcare

  • Piedmont QCN in MSSP (track-dependent)
  • Atlanta and other MSA CJR participation
  • Statewide footprint enables multi-model participation

Northside Hospital System

  • MSSP participation
  • ACO REACH participation
  • Atlanta MSA CJR
  • Other CMMI specialty models

Aledade Georgia ACOs

  • Multiple MSSP ACOs across BASIC levels and ENHANCED
  • ACO-as-a-Service infrastructure
  • Strong PCF and other primary-care-focused model participation

Privia Medical Group Georgia

  • ACO infrastructure
  • MSSP participation
  • Specialty-focused CMMI model exposure

Georgia FQHC ACO networks

  • MSSP participation via ACO networks
  • FQHC-specific CMMI considerations

Selected Georgia oncology practices

  • Enhancing Oncology Model (EOM) participation
  • Selected practices statewide

Selected Georgia kidney care networks

  • Kidney Care Choices (KCC) participation

Worked examples

Example 1: Fulton 70 — Emory CIN MSSP participation

Dr. Patel, age 70, internal medicine at Emory Decatur. Emory CIN ACO participates in MSSP ENHANCED (Advanced APM). Section 1899 SSA-based MSSP is operationally administered by CMMI/CMS:

  • Emory CIN ACO operates under MSSP ENHANCED rules per 42 CFR Part 425
  • Dr. Patel's beneficiaries attributed to the ACO based on claims patterns
  • ACO bears 75% downside risk for losses, shares 75% upside for savings
  • Quality reporting via APP
  • Dr. Patel achieves QP status (75%+ Part B Professional Services through MSSP ENHANCED Advanced APM)

Example 2: DeKalb 75 — Northside ACO REACH Global

Mrs. Johnson, age 75, Northside Hospital primary care patient. Northside participates in ACO REACH Global Track:

  • Mrs. Johnson's primary care attribution drives ACO REACH alignment
  • Northside ACO REACH Global bears full risk for total cost of care
  • Health Equity Benchmark Adjustment applies given Atlanta socioeconomic mix
  • Mrs. Johnson receives enhanced care coordination, home visits, transportation benefits, etc.
  • Northside's participating clinicians achieve QP status

Example 3: Cobb 68 — Atlanta MSA CJR mandatory hip replacement

Mr. Williams, age 68, elective primary total hip arthroplasty at Wellstar Kennestone Hospital. Atlanta MSA is a CJR-participating MSA:

  • Hospital participates in CJR (mandatory in Atlanta MSA)
  • 90-day episode begins at hospital admission
  • All Part A and Part B services within 90 days included in episode
  • Hospital coordinates with SNFs, home health, and outpatient rehab to manage post-discharge costs
  • Episode cost reconciled against CJR target price
  • Quality measures (Hip/Knee Complications, HCAHPS, Voluntary PRO) affect target price calculations
  • Hospital owes Medicare (if over target) or receives savings (if under)

Example 4: Worth County 72 — Albany Area FQHC Aledade MSSP BASIC E

Mrs. Smith, age 72, Albany Area Primary Health Care FQHC patient. FQHC participates in Aledade Georgia MSSP BASIC E ACO:

  • MSSP BASIC E is Advanced APM (two-sided risk)
  • Mrs. Smith's attribution drives ACO performance assessment
  • Aledade's centralized infrastructure manages Quality reporting via APP
  • High-ADI Worth County population qualifies ACO for Health Equity Adjustment in MSSP Quality Performance Standard
  • FQHC clinicians achieve QP status via Aledade BASIC E participation

Example 5: Bibb 80 — Macon EOM enhanced oncology

Mr. Davis, age 80, newly diagnosed lung cancer at a Macon oncology practice participating in Enhancing Oncology Model (EOM):

  • EOM is CMMI episode-based oncology payment model
  • 6-month chemotherapy episodes
  • Practice provides enhanced services (24/7 access, patient navigation, palliative care coordination, comprehensive care plans, etc.)
  • Practice bears performance-based payment risk
  • Outcomes tracked via cancer-specific quality measures

Example 6: Hall 67 — Gainesville Primary Care First (PCF) practice

Dr. Singh, age 67, Gainesville primary care practice participating in PCF:

  • PCF is CMMI capitated primary care model
  • Quality-adjusted population-based payment (replaces FFS for primary care)
  • Performance-based adjustment based on quality and patient outcomes
  • Advanced APM — Dr. Singh achieves QP status via PCF participation
  • Practice transformation supported by PCF infrastructure payments

Best practices for Georgia CMMI participants

  1. Monitor annual CMMI announcements — New models, model extensions, and modifications announced via Federal Register and innovation.cms.gov
  2. Evaluate model fit for practice — CMMI models have distinct participant requirements; choose models aligned with practice capabilities
  3. Engage with specialty society resources — AMA, ACC, ACOG, AAO, etc. publish CMMI model guidance
  4. Coordinate with system-level CMMI strategy — Major Georgia integrated systems coordinate CMMI participation across service lines
  5. Plan QP threshold strategy — Advanced APM participation meeting QP thresholds exempts from MIPS and provides Qualifying APM CF differential
  6. Engage health equity infrastructure — Health Equity Plan, ADI tracking, disparities reporting now central to many CMMI models
  7. Monitor CJR coordination — Atlanta MSA hospitals must manage 90-day post-discharge episodes for hip/knee bundles
  8. Track evaluation results — Independent evaluator reports drive future model decisions; engage with evaluation findings
  9. Participate in CMS listening sessions — RFA development includes stakeholder engagement opportunities
  10. Plan multi-year participation — CMMI models typically run 4-6 years; commit operationally and financially
  11. Coordinate with Acentra Health QIO — 1-844-455-8708 for Georgia CMMI model TA
  12. Engage NAACOS and other associations — National Association of ACOs and similar bodies provide model-specific guidance
  13. Document model participation for QP determination — APM Entity participation lists drive QP status
  14. Monitor Section 1115A(c) certification announcements — Successful models may expand nationally

Common CMMI participation issues for Georgia

  1. Missing application/recruitment windows — CMMI model applications have firm deadlines
  2. Underestimating participation costs — Quality reporting infrastructure, CEHRT requirements, care management staffing
  3. Misaligning with QP threshold — Advanced APM participation must produce QP if QP status is the goal
  4. CJR mandatory exposure — Atlanta MSA hospitals must participate regardless of preference
  5. Health Equity Plan complexity — ACO REACH and emerging models require operational Health Equity Plans
  6. Confusing Section 1899 MSSP and CMMI models — MSSP is statutory, not CMMI; ACO REACH is CMMI
  7. Section 1115A(c) certification confusion — Few models have been formally certified; expansion is rare
  8. Model interaction confusion — Some models cannot be combined (e.g., MSSP + PCF)
  9. Evaluation period uncertainty — Final evaluation reports may take years; participation must continue regardless
  10. Two-sided risk underestimation — Advanced APM participation requires bearing financial risk
  11. Geographic eligibility constraints — Some models limited to specific states/regions/MSAs
  12. Specialty exclusivity — Specialty models like EOM and RO Model only available to relevant specialty practices
  13. Beneficiary attribution misunderstanding — Different models use different attribution rules
  14. Strategic planning gaps — Multi-model strategy across system service lines requires coordination

Frequently Asked Questions

1. What is the CMS Innovation Center (CMMI)? CMMI is the federal laboratory for Medicare and Medicaid payment and care delivery innovation. Established by Section 3021 of the Patient Protection and Affordable Care Act (Public Law 111-148, March 23, 2010) under Section 1115A of the Social Security Act. CMMI has $10 billion appropriated per 10-year period under Section 1115A(f) and unique certification and expansion authority under Section 1115A(c).

2. When was CMMI established? By Section 3021 of the ACA (Public Law 111-148), signed March 23, 2010. CMMI began operations later that year.

3. What is the CMMI funding amount? $10 billion appropriated per 10-year period (approximately $1 billion per year). Permanent appropriation, not subject to annual congressional appropriations.

4. What is Section 1115A(c) certification authority? The HHS Secretary may expand a CMMI model nationwide through rulemaking if it reduces program expenditures without reducing quality, or improves quality without increasing expenditures. This authority is unique to CMMI.

5. What are the three CMMI strategic goals (October 2021 Strategy Refresh)? Accountable Care, Health Care Quality, and Health Equity.

6. What is ACO REACH? The Accountable Care Organization Realizing Equity, Access, and Community Health Model. Operational January 1, 2023 through December 31, 2026. CMMI's flagship Health Equity-focused ACO model. Professional and Global tracks. Replaced Direct Contracting (GPDC).

7. What is Primary Care First (PCF)? A CMMI capitated primary care model with quality and outcomes incentives. Advanced APM. Provides QP status to participating clinicians meeting thresholds.

8. What is Making Care Primary (MCP)? A CMMI primary care transformation model launched 2024 in selected states (Georgia not in first wave). Three-track design. Multi-year care transformation.

9. What is Kidney Care Choices (KCC)? A CMMI value-based kidney care model including Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC). Advanced APM.

10. What is the Enhancing Oncology Model (EOM)? A CMMI episode-based oncology payment model. Five-year model. Replaced the Oncology Care Model (OCM) that ended June 2022.

11. What is BPCI Advanced? Bundled Payments for Care Improvement Advanced. CMMI voluntary episode-based bundled payment model across surgical and medical episodes. Advanced APM.

12. What is CJR? Comprehensive Care for Joint Replacement Model. Mandatory CMMI model for hip and knee arthroplasty bundles in selected Metropolitan Statistical Areas, including Atlanta MSA. Episodes are 90 days following hospital discharge.

13. Is the Atlanta MSA a CJR participating MSA? Yes. Atlanta MSA has been a CJR participating MSA since the model launched April 1, 2016. Atlanta MSA hospitals (Wellstar, Emory, Piedmont, Northside, and others) participate in CJR.

14. What is the Maryland Total Cost of Care Model? A CMMI statewide total cost of care model for Maryland. Maryland-specific framework. Lessons inform other state-based CMMI models.

15. What were the predecessor ACO models? Pioneer ACO (ended 2016) and Next Generation ACO (ended 2021). Lessons fed into MSSP and ACO REACH.

16. How does CMMI evaluate models? Independent contractors (RTI International, Mathematica, Abt Associates, The Urban Institute, Lewin Group, NORC) evaluate using rigorous methodologies (difference-in-differences, propensity-score matching, regression discontinuity, mixed-methods qualitative).

17. What is the relationship between CMMI and MSSP? MSSP is established under Section 1899 of the Social Security Act, not Section 1115A (CMMI's statute). However, MSSP and CMMI evolved together; MSSP is operationally administered alongside CMMI models; Pioneer ACO (a CMMI predecessor) directly informed MSSP design.

18. Which CMMI models qualify as Advanced APMs for QP status? Currently: ACO REACH Professional and Global; PCF; KCC; MCP; BPCI Advanced; and various other two-sided risk CMMI models. Each annually verified per Advanced APM list.

19. How do Georgia integrated systems engage with CMMI? Wellstar, Emory, Piedmont, Northside participate across MSSP, ACO REACH, CJR, specialty models. Engagement typically coordinated through dedicated ACO operations and value-based care leadership.

20. What is the Health Equity Benchmark Adjustment? A CMMI methodology used in ACO REACH (and increasingly in MSSP) that adjusts ACO benchmarks based on Area Deprivation Index (ADI) and dual-eligible enrollment to provide more favorable benchmarks for ACOs serving underserved populations.

21. How can a Georgia practice apply to participate in a CMMI model? Via competitive Request for Applications (RFA) issued by CMMI. Application windows are model-specific. Watch innovation.cms.gov for announcements.

22. What is CMMI's biennial reporting requirement? Section 1115A(g) requires CMMI to report to Congress every two years on activities, models tested, evaluation findings, and recommendations.

23. Does CMMI test Medicaid models too? Yes. CMMI's statutory authority covers Medicare, Medicaid, and CHIP. State-based models (SIM, MCP, AHEAD, etc.) often involve Medicaid alignment.

24. How does CMMI interact with state Medicaid agencies? For Medicaid-relevant models, CMMI partners with state Medicaid agencies. Georgia's Department of Community Health (DCH) is the relevant Medicaid agency for any future Medicaid CMMI engagement.

25. Where can Georgia providers and beneficiaries learn more about CMMI? innovation.cms.gov is the primary CMMI website. QPP Service Center 1-866-288-8292 for QPP-related CMMI model questions. Acentra Health QIO 1-844-455-8708 for free Georgia model TA. NAACOS, Medical Association of Georgia (MAG), and specialty societies provide model-specific guidance.

Resources and Contacts

For CMMI questions:

  • CMS Innovation Center: innovation.cms.gov
  • Medicare: 1-800-MEDICARE (1-800-633-4227)
  • QPP Service Center: 1-866-288-8292
  • Palmetto GBA Part A/B MAC Jurisdiction J: 1-866-238-9650
  • Acentra Health QIO (Georgia): 1-844-455-8708 (free CMMI TA)
  • GeorgiaCares SHIP: 1-866-552-4464
  • Medicare Rights Center: 1-800-333-4114
  • Atlanta Legal Aid Society: 404-377-0701
  • Georgia Legal Services Program: 1-800-498-9469
  • 211 Georgia: Dial 211
  • Eldercare Locator: 1-800-677-1116
  • Social Security Administration: 1-800-772-1213
  • Benefits Coordination & Recovery Center (BCRC): 1-855-798-2627
  • National Association of ACOs (NAACOS): naacos.com
  • Medical Association of Georgia (MAG): mag.org
  • Georgia Department of Community Health (Medicaid): dch.georgia.gov
  • Georgia Composite Medical Board: 404-656-3913

Why CMMI matters for Georgia value-based care

The CMS Innovation Center is the federal architect of modern Medicare value-based care. Section 1115A's $10 billion per 10-year appropriation and unique certification authority under Section 1115A(c) have allowed CMMI to test dozens of models across ACOs, primary care, specialty care, episode-based bundles, and state-based frameworks. The October 2021 Strategy Refresh's three goals — Accountable Care, Health Care Quality, and Health Equity — guide model design going forward. For Atlanta MSA hospitals operating under mandatory CJR bundles, for Emory and Piedmont and Wellstar and Northside coordinating MSSP and ACO REACH and selected CMMI specialty models, for Aledade Georgia ACOs and Privia Medical Group Georgia driving MSSP participation, for Georgia FQHCs participating via ACO networks, for Macon oncologists participating in EOM, for Gainesville primary care in Primary Care First — CMMI is the source of the value-based-care opportunities that define Georgia Medicare provider strategy. Understanding CMMI — the statutory framework, the model portfolio, the evaluation methodology, the strategic goals, the certification authority — is essential for every Georgia provider, payer, and beneficiary navigating Medicare's value-based future.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.