A Government Accountability Office audit of the Center for Medicare and Medicaid Innovation Center’s historical spending and the outcomes of its models has reignited lawmaker calls to increase scrutiny over its work.
The report, prompted by a 2024 request from House Budget Committee leaders and published last week, outlined 70 delivery and payment models that CMMI developed and tested between 2011 and 2024.
As of January 2025, 24 of those remained in active testing and just four had been scaled for nationwide implementation, though GAO noted that some elements of those models have been incorporated into Medicare and that iterative successor models are also being tested.
Additionally, the audit outlined a total of $11.4 billion was obligated to CMMI during that 14-year window, with obligations peaking at $1.3 billion in FY2015 and dipping to $789 million in FY2024. The reduction was attributed by CMMI 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.
“Specifically, the Innovation Center has centralized common model functions to be more cost efficient, according to officials,” GAO wrote in the report. “For example, officials noted that the agency created centralized resources to support certain activities—like information technology and quality measure development—which simplified contract administration.”
CMMI was established under the 2010’s Affordable Care Act, which obligated $10 billion per decade for the center to pursue federal healthcare spending reductions and quality improvements.
The new audit’s report of four nationally scaled models adds fuel to the fire for the CMMI’s critics, whose calls for reform are backstopped by a 2023 Congressional Budget Office (CBO) assessment that found CMMI increased indirect spending by $5.4 billion during its first decade (0.1% of net Medicare spending during that time). CBO initially predicted that CMMI would yield savings and, in a subsequent projection, estimated that the center would increase federal spending by $1.3 billion from FY2021 to FY2030.
In a statement released this week, Rep. Jodey Arrington, R-Texas, who chairs the House Budget Committee, said CMMI has failed on both its quality and savings charges.
“A [5.7%] success rate isn’t innovation—it’s failure,” he said. “And with our national debt barreling past $39 trillion, we can’t afford programs that promise savings but consistently come up short.”
Arrington noted that the center’s mission “is too important to abandon,” and that the effort would be better executed under the Trump administration.
“I’m encouraged by Secretary Kennedy’s and CMS Administrator Oz’s commitment to rooting out waste, fraud and abuse and ensuring the Innovation Center finally delivers on its promise—for patients and for taxpayers.”
The early days of the new administration brought sweeping change for CMMI, with officials promising a “data-driven review” of all current models and the premature conclusion of several by the end of 2025, citing hundreds of millions in expected cost savings. Among the new pilot programs it has floated since are the Medicare Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model, which promotes the use of new technology to treat chronic diseases; the Wasteful and Inappropriate Service Reduction (WISeR) model, which uses yet-to-be-detailed technologies to introduce prior authorization into traditional Medicare; and a pair that will factor international prices into inflationary rebates drug manufacturers must pay to Medicare Part B and Part D for certain products.
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