John Kautter

John Kautter, PhD, is a principal scientist and senior health economist at RTI International, specializing in the development, implementation, and evaluation of health care payment models. He currently serves as project director for RTI’s contract with the Centers for Medicare & Medicaid Services (CMS) providing technical assistance and operations support for the ACO REACH Model and Kidney Care Choices (KCC). Dr. Kautter also directs RTI’s risk adjustment research and development work for Medicare Part C, Medicare Part D, and the Affordable Care Act (ACA), and serves as associate project director for the Medicare Prescription Drug Price Negotiation Program.

Dr. Kautter has played a central role in developing many of CMS’s most important payment models. He co-led the creation of the CMS-Hierarchical Condition Category (HCC) risk adjustment model for Medicare Advantage and led development of the HHS-HCC model for ACA Marketplaces. His work in Medicare Part D includes developing the original Rx-HCC model using prescription drug event (PDE) data, and leading Part D payment demonstration evaluation efforts. He has also contributed to accountable care innovations, including serving as project director for the Next Generation ACO Model, and associate project director for the Physician Group Practice Demonstration and for the Medicare Shared Savings Program. Dr. Kautter has additionally led competitive bidding model development, such as the Medicare Clinical Laboratory Competitive Bidding Demonstration.

With a strong foundation in data analysis, Dr. Kautter has led studies using administrative claims, survey data, and advanced statistical methods. His experience includes evaluating TRICARE disease management demonstrations, analyzing selection bias in Medicare Preferred Provider Organizations, developing payment models for frail and functionally impaired Medicare beneficiaries, assessing insurance expansion for the National Guard and Reserves, and addressing nonresponse bias in the Medicare Current Beneficiary Survey. He has published over 20 articles in peer-reviewed journals, including Health Economics, Medical Care, Health Affairs, and Health Services Research, and is recognized nationally for his expertise in federal payment policy and reform.