CMS makes mark with flurry of value-based care, payment models

Modern Healthcare – Tuesday, January 13, 2026
By Bridget Early

The Centers for Medicare and Medicaid Services has thrown a lot of new payment models at providers and value-based care organizations since President Donald Trump returned to the White House a year ago.

The agency’s Center for Medicare and Medicaid Innovation rolled out a slew of demonstrations in 2025, including a half a dozen in December alone. The healthcare sector is sorting through what it all adds up to as CMS strives to fulfill the agenda it announced last May.

Recent endeavors include several drug pricing models, a two-sided risk demonstration for accountable care organizations, a pair of technology-focused payment experiments and two pilots focused on chronic care. CMMI also nixed a handful of models, tweaked others and maintained one hospital bundled payment model from the previous administration despite industry opposition.

On the whole, value-based care organizations are excited about the menu of new pilots, some of which could mitigate longstanding quality and cost conundrums. But a host of details still needs to be addressed.

“It was a lot — a head-spinning end of the year in terms of model announcements,” said Mara McDermott, CEO of the value-based care trade group Accountable for Health. “There are a lot of positives there, but it also means there’s a lot to figure out.”

CMMI’s first year in Trump’s second term contrasts with how it operated under President Joe Biden, McDermott said. The previous administration consolidated the innovation center’s portfolio, while the Trump administration has been prolific with new programs, McDermott said. “We are all now feeling the impact of that shift in philosophy,” she said.

“This CMMI seems to be taking a very different approach, which is more of the ‘let a thousand flowers bloom,’ seeing what works and where we can get savings, and really deploying a combination of voluntary and mandatory models aimed at getting lots of different types of entities and lots of different types of providers and participants in the ecosystem,” McDermott said.

The Trump administration also is carrying out these models in ways that could enable them to stick around, said Aisha Pittman, senior vice president of government affairs for the National Association of ACOs.

CMS payment models often don’t take effect until at least a year after they are announced. But the Trump administration is moving more quickly. That positions CMMI to oversee the first several years of implementation and efforts to demonstrate results. And once the models are operating, it’s harder for future administrations to shut them down, Pittman said.

For providers and others that participate in CMMI demonstrations, the downside to this deluge is they must clamor for details about a variety of initiatives at once and quickly reckon with how programs interact with each other and with models already in place.

CMMI has released information about new models on a piecemeal basis, which complicates planning for the private sector.

That means, for instance, a waiting game on complex two-sided risk models such as Long-term Enhanced ACO Design, or LEAD, the successor to the ACO Realizing Equity, Access and Community Health model, or ACO REACH, which ends this December.

Potential participants still need key information on LEAD’s benchmarking and risk-adjustment rules, Pittman said. The clock is ticking for ACO REACH participants to assess whether to join LEAD or transition to the Medicare Shared Savings Program, Pittman said. The deadline for LEAD participation will likely be September, she said.

“Our overarching concern is: Do providers have enough time to really fully evaluate this model and make decisions?” Pittman said.

CMS also needs to clarify how its new models could overlap, said Susan Dentzer, president and CEO of America’s Physician Groups, which represents medical practices.

Dentzer pointed to the Advancing Chronic Care with Effective, Scalable Solutions, or ACCESS, model, which tests paying providers for using telehealth, wearables and other digital tools.

While providers support the premise of models such as ACCESS, care-coordination issues could arise for providers with patients in multiple models that have similar goals, such as diabetes management, Dentzer said.

“We would rather see them get it right than rush into the market with something that’s flawed in some way,” Dentzer said.

CMMI should consider using notes in patient medical records to flag which models are connected to which enrollees, along with offering ACOs beneficiary-level data in instances when models overlap, Pittman said.

Other initiatives, such as the Wasteful and Inappropriate Service Reduction, or WISeR, Model, are already in effect, but their rollouts haven’t gone perfectly smoothly. For example, providers complain they have yet to hear from the technology vendors managing WISeR, which seeks to test prior authorization requirements in fee-for-service Medicare.

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