What the New CMS and CMMI Models Signal About the Future of Value-Based Payment
CMS and the Innovation Center (CMMI) are launching and reshaping multiple models at the same time, including AHEAD (Geo AHEAD), the ASM, ACCESS, BALANCE, LEAD, MAHA ELEVATE, and the Rural Health Transformation Program (RHTP). Each targets different populations and care settings, from specialists treating heart failure and low back pain to rural health systems and lifestyle medicine programs. Taken as a portfolio, these models signal where federal health policy is headed: a more modular, diversified approach to value-based payment. There are now more pathways than ever to participate, but also more strategic choices to make, creating real implications for providers, health systems, risk-bearing entities, and technology partners deciding where to focus their investments and capabilities.
Targeted Opportunities Across Populations and Care Settings
For much of the past decade, participation in Medicare Shared Savings Program (MSSP) ACOs or similar population-based models was the most common route into value-based payment. Today, CMMI is offering multiple, targeted pathways that reflect the diversity of populations, care settings, and organizational readiness, including:
Specialist accountability through the Ambulatory Specialty Model (ASM) for heart failure and low back pain
Geographic accountability through AHEAD and Geo AHEAD
Prevention and behavior change through MAHA ELEVATE and BALANCE
Technology-enabled chronic disease management through ACCESS
Advanced ACO participation through LEAD for organizations ready for higher levels of population-based accountability
Rural health system transformation through RHTP
Instead of asking every organization to enter the same type of risk arrangement, CMS is testing multiple levers at once. This reflects a recognition that health care delivery challenges differ by population, region, and care setting.
What These Models Have in Common
Although these models look different on the surface, they share several underlying themes.
Targeted Accountability
CMMI is moving away from broad, generalized accountability and toward more specific responsibility:
Specialists are accountable for condition-level performance under ASM.
Regions are accountable for total cost and quality under Geo AHEAD.
Intervention operators are accountable for outcomes under MAHA ELEVATE and ACCESS.
This approach tightens the link between behavior and financial consequences and allows CMS to test whether targeted accountability produces better results than broad population-level risk alone.
Infrastructure Matters as Much as Payment
Models like AHEAD and RHTP focus as much on systems and capacity as on reimbursement. Workforce shortages, hospital sustainability, data infrastructure, and community partnerships are now central to the federal transformation strategy. Payment reform alone is no longer viewed as sufficient to improve outcomes, particularly in rural and underserved areas.
Evidence Before Permanence
Models such as MAHA ELEVATE and BALANCE are designed to build evidence about whole-person care, lifestyle medicine, and metabolic health interventions. CMS is signaling that it wants proof of clinical impact and cost reduction before making these approaches part of permanent Medicare coverage and payment policy.
Why This Matters for Providers and Health Systems
For providers and health systems, this new generation of models creates real strategic choices. Participation is no longer just about whether to join value-based care, but about how to engage.
Some organizations may be positioned to apply directly as participants in models like LEAD or ACCESS. The LEAD Model signals that CMS still views advanced ACOs as a core pathway for organizations capable of managing long-term population-based risk, even as it experiments with more targeted models for specific conditions and settings. Others may find that partnering with a lead entity or technology provider is more realistic. Still others may choose to watch and prepare while building internal capabilities.
For example:
A cardiology group treating heart failure patients may need to prepare for mandatory participation in ASM, even if it is not otherwise pursuing risk-based contracts.
A rural hospital system may see more opportunity through state-led RHTP initiatives than through traditional ACO participation.
A health system exploring prevention and metabolic health may view MAHA ELEVATE or BALANCE as a way to test new care models without fully restructuring existing payment arrangements.
Implications for Risk-Bearing Entities and Technology Partners
The expanding set of models also creates new roles for enablers, aggregators, and vendors.
Risk-bearing entities are increasingly asked to support:
Specialist performance management (ASM)
Long-term population-based risk management and governance under advanced ACO models (LEAD)
Regional accountability structures (Geo AHEAD)
Rural system redesign (RHTP)
Outcome-based intervention delivery (ACCESS and MAHA ELEVATE)
Technology partners face a shift as well. Rather than selling tools only to providers, some models (particularly ACCESS) position technology-enabled care directly as the billable service. Others require tools that support population outreach, quality reporting, or lifestyle intervention tracking.
This evolution blurs traditional boundaries between payer, provider, and vendor roles and makes strategic positioning more important than ever.
Participation Is No Longer the Only Goal
One of the clearest signals from this new wave of models is that participation alone is not the objective. CMS is implicitly recognizing that different organizations will play different roles in transformation. Applying, partnering, and watching are all legitimate strategies depending on readiness, market context, and long-term goals.
Organizations that succeed will be those that can answer questions such as:
Which of these models aligns with our patient populations and clinical strengths?
Where do we have the infrastructure to manage accountability?
How do these models fit with our existing contracts and partnerships?
A More Complex, More Strategic Landscape
Together, AHEAD, ASM, ACCESS, BALANCE, MAHA ELEVATE, and RHTP reflect a more complex but also more intentional federal strategy. Rather than forcing all participants into a single model, CMS is testing targeted approaches for specialists, regions, prevention, technology-enabled care, and rural systems.
For health care leaders, this means the core challenge is no longer simply understanding the models. It is determining what role makes sense to play within them.
Learn More: Navigating the New CMMI Models
At Coral Health Advisors, we work with providers, health systems, states, and solution partners to assess where new CMMI models create real opportunity and where they introduce unnecessary complexity. Connect with our team to evaluate fit, clarify your role, and shape a strategy grounded in your capabilities.