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CMMI has lost $5.4B. Now, lawmakers are questioning its value.

A new GAO report found a 5% success rate for models tested by the CMS Innovation Center, prompting lawmakers to consider reform to advance value-based care.

Jacqueline LaPointe
By
Published: 02 Apr 2026

Congress established the CMS Innovation Center to add value to a strained healthcare system. Sixteen years later, lawmakers are questioning the Center after a new report shows just a 5.7% success rate on its alternative payment and service delivery models.

The March 27 report from the Government Accountability Office (GAO) found that the CMS Innovation Center, also known as CMMI, has tested 70 models from 2011 through 2024, including 24 active models as of January 2025. However, CMMI has expanded just four models nationwide.

Nationwide expansion is the core statutory goal for CMMI models. HHS can expand a model if it reduces federal spending without compromising quality of care or improves quality without increasing spending. The expansion must also not deny or limit coverage for beneficiaries. Then, the CMS Chief Actuary must certify that the expansion will reduce federal spending.

So far, the CMMI models that met the requirements for nationwide expansion are the Pioneer Accountable Care Organization (ACO) Model, the Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization Model, the Medicare Diabetes Prevention Program and the Home Health Value-Based Purchasing Model. The latter two models were expanded within CMMI's portfolio, while the former were or had model elements incorporated into CMS programs, including the Medicare Shared Savings Program.

GAO found that CMMI has identified factors that affect the potential for model savings, including generous incentive payments to participants, selection bias and participation attrition, all of which CMMI associated with voluntary models.

The vast majority of CMMI models have been voluntary, with only two mandatory models currently being tested: the Increasing Organ Transplant Access Model, starting in July 2025, and the Transforming Episode Accountability Model, starting in January 2026. CMMI also plans to launch the mandatory Ambulatory Specialty Model in January 2027.

Additionally, GAO stated that the typical test duration of less than 10 years may make achieving federal savings difficult, particularly if the models aim to improve preventive and primary care.

A beacon of innovation or an utter failure?

The latest GAO report on CMMI confirms what some lawmakers say is a failure.

"A 5 percent success rate isn't innovation -- it's failure. And with our national debt barreling past $39 trillion, we can't afford programs that promise savings but consistently come up short," House Budget Chairman Jodey Arrington (R-Texas) said in a statement Tuesday.

Chairman Arrington, alongside then-Health Care Task Force Chairman Representative Michael Burgess (R-Texas), called for this GAO report to update the cost of CMMI and its effect on federal spending. At the time, the representatives said that CMMI had already failed to deliver on its mandate to save taxpayer money and improve the quality of care for Medicare and Medicaid beneficiaries.

The latest report shows little progress at CMMI. The March 2018 report from GAO revealed that CMMI had tested or was testing 37 models, with just two Medicare models recommended for expansion.

While double the number of models has now been recommended for expansion after demonstrating cost savings, CMMI is still operating at a loss. Figures from the Congressional Budget Office (CBO) cited in the GAO report show a net loss of $5.4 billion from fiscal years 2011 through 2020. The loss stems from $7.9 billion spent on testing models during that time, with just $2.6 billion yielded in savings.

CBO projected CMMI to continue to increase federal spending by another $1.3 billion in its second decade.

Chairman Arrington said CMMI has significant unobligated funds, which GAO reported was $8.0 billion as of the end of fiscal year 2024. In total, CMMI had obligations of $11.4 billion from 2011 to 2024. She also pointed to slow implementation rates, ineffective quality measures and poor model design.

CMMI is "too important to abandon"

Despite calling out CMMI's failures, Chairman Arrington said its "mission is too important to abandon."

CMMI is a champion for value-based care, testing models that shift payers and providers away from fee-for-service reimbursement. Value-based care models promise to do away with the incentives to maximize care volume, instead holding providers accountable for quality outcomes, total cost of care and other metrics.

However, the transition to value has been underway for over a decade and counting.

The healthcare industry is about halfway there, according to the latest data from America's Health Insurance Plans.

Nearly 45% of payments flowed through alternative payment models with some financial risk, revealed the data from 58 health plans, two fee-for-service Medicaid states and Traditional Medicare, representing over 271 million people nationwide in 2024.

Another 15.4% of payments had only a link to quality and value, while the remaining 39.7% were based on fee-for-service.

CMS aims to have all Traditional Medicare beneficiaries in a relationship with a provider accountable for quality and total cost of care by the end of this decade. However, efforts to transition providers into accountable models seem to have stalled.

"[T]he status quo is unacceptable," Chairman Arrington stated. "It's time for real accountability, models that actually deliver results, and a relentless focus on delivering better access and better outcomes at a lower cost."

Arrington believes CMMI has the potential under the Trump administration to "deliver on its mission by implementing new models to lower costs and Make America Healthy Again."

The Trump administration has already made a mark on CMMI in its second term.

CMMI announced last year a new strategy focused on "improving the health of Americans through disease prevention via evidence-based practices, empowering individuals with information to make informed decisions, and promoting choice and competition."

As part of the new strategy, CMMI terminated four models -- the Primary Care First, Making Care Primary, the mandatory ESRD Treatment Choices and the Maryland Total Cost of Care models -- and reduced the scope of the Integrated Care for Kids model, which it recently replaced with the voluntary Accelerating State Pediatric Innovation Readiness and Effectiveness, ASPIRE, Model.

CMMI also recently announced other models aligned with HHS' Making America Health Again (MAHA) approach. Those models include the Advancing Chronic Care with Effective, Scalable Solutions, or ACCESS; Better Approaches to Lifestyle and Nutrition for Comprehensive Health, or BALANCE; and the MAHA Elevate Models. It also released the successor to the ACO Realizing Equity, Access, and Community Health, or REACH, Model.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.

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