The purpose of this work is to develop the payment methodology and perform financial calculations necessary for payment reconciliation for a new initiative within the center for medicare and…

The Centers for Medicare and Medicaid Services (CMS) awarded a $15.9 million delivery order to Mathematica Inc. under the Research, Measurement, Assessment, Design, and Analysis (RMADA) Indefinite Delivery Vehicle to develop payment methodology and perform financial calculations for the Comprehensive Care for Joint Replacement (CJR) Payment Reconciliation Model. The effort, which ran from September 2015 through March 2022, supports the CMS Center for Medicare and Medicaid Innovation's Patient Care Models Group in testing bundled payment approaches for episodes of care during and after hospital stays for specified Medicare Severity Diagnosis-Related Groups. The model builds upon the existing Bundled Payments for Care Improvement (BPCI) initiative but represents a separate new model developed under authority granted by Section 3021 of the Affordable Care Act. This delivery order was awarded on a cost-plus-fixed-fee basis with no set-aside designation, reflecting Mathematica's status as an established federal contractor.

Mathematica Inc., a woman-owned research and data analytics consultancy headquartered in Washington, DC and subsidiary of Research Triangle Institute International, is a premier federal contractor specializing in program evaluation, policy research, and technical assistance across multiple policy domains. The company's extensive experience supporting CMS and other federal agencies in healthcare policy, including prior work on the original BPCI initiative, positioned it to lead this complex payment reconciliation effort. Work was performed in Windsor Mill and Milford Mill, Maryland, with the contract leveraging Mathematica's established capabilities in rigorous analytical practices and healthcare program evaluation to support evidence-based decision-making within Medicare innovation initiatives.

The purpose of this work is to develop the payment methodology and perform financial calculations necessary for payment reconciliation for a new initiative within the center for medicare and medicaid innovation?s (cmmi) patient care models group (pcmg). This new model will test the use of bundled payment for an episode of care during and after a hospital stay for specified medicare severity diagnosis-related groups (MS-drgs). The new model will build on the existing cmmi bundled payments for care improvement (bpci) initiative, but this is a new model that is separate from bpci. Details of the model are still under development. This effort is under the authority identified in section 3021 of P.L. 111-148.