Health Care Matters | February 6
New Funding Package Extends Telehealth and APM Incentives, Leaves ACA Subsidies Unaddressed
A $1.2 trillion spending package signed into law on February 3 extends several Medicare policies central to value-based care through September 2026. The legislation extends the 3.1% APM incentive payment for physicians participating in qualifying Alternative Payment Models in 2026, preserving bonus structures tied to the Quality Payment Program. The package also provides a two-year extension of Medicare telehealth flexibilities through December 31, 2027, maintaining expanded originating sites, eligible practitioner types, audio-only services, and telehealth use by FQHCs and RHCs, while introducing new coding and modifier requirements beginning in 2027. Additionally, the bill extends the Acute Hospital Care at Home waiver through September 30, 2030 and directs CMS to evaluate the program's quality, safety, cost, utilization, and equity impacts. Notably absent from the legislation: any extension or modification of ACA marketplace premium tax credits or subsidy policy. Read more here, here, and here.
Why It Matters
This funding package prioritizes continuity and predictability over major policy shifts. Extending the APM incentive payment preserves a critical financial signal for providers and conveners already invested in Advanced APM participation, supporting continued care model and infrastructure investments.
The multi-year telehealth extension provides welcome operational stability for care management, behavioral health, and rural access strategies, while the introduction of future coding and modifier requirements signals CMS’s increasing focus on oversight and program integrity. The hospital-at-home extension creates a longer runway for health systems to scale home-based acute care as a capacity and cost-management strategy, but the required CMS evaluation suggests heightened scrutiny and a growing evidence bar for long-term permanence.
At the same time, the omission of ACA subsidy extensions underscores that this package is narrowly focused on preserving existing Medicare tools, not addressing broader affordability or coverage gaps, reinforcing the incremental, Medicare-centered nature of current federal health policy.
APM Adoption Continues to Grow Across Payers
The 2025 APM Measurement Methodology Report from AHIP finds that 44.9% of U.S. healthcare payments flowed through alternative payment models (APMs) in 2024, essentially flat from 45.2% in 2023. Advanced APMs with downside risk or population-based accountability also held steady at 28.7%, while 39.7% of payments remained traditional fee-for-service (FFS). Covering 271 million lives across commercial, Medicare Advantage, Medicaid, and Original Medicare, the data show wide variation by market: Medicare Advantage continues to have the highest share of payments in APMs at roughly 60%, while commercial adoption remains lower at 38.9%, with about half of payments still FFS. Despite the plateau, 70% of surveyed plans expect APM use to grow over the next two years, particularly through bundled and episode-based payment models. Read more here.
Why It Matters
The leveling off suggests the value-based care transition is entering a more challenging phase. After years of experimentation and incremental expansion, the remaining opportunity lies in converting entrenched FFS arrangements and improving performance in models that already carry risk. The persistent gap in commercial adoption is notable and reflects ongoing concerns about operational complexity, provider readiness, and the consistency of savings under accountability-based contracts. At the same time, federal policy is increasingly focused on tightening expectations rather than broadening participation, including mandatory episode-based payment through TEAM and the transition from ACO REACH to the LEAD model. For providers and risk-bearing organizations, the implication is less about whether to participate in value-based payment and more about whether they have the infrastructure, governance, and clinical capabilities to succeed as accountability becomes more durable and less optional.
Look for the Helpers: Mobile Mammography Expands Breast Cancer Screening for Rural Veterans
The Department of Veterans Affairs is partnering with local health systems to bring mobile mammography services directly to rural Veterans in Tennessee and Georgia. A mobile screening unit travels to VA clinic sites, making it easier for Veterans to access preventive breast cancer screenings without long-distance travel. The program also uses digital outreach tools to help schedule appointments and improve participation. After screenings, Veterans are connected with coordinated follow-up care and navigation support as needed. The initiative shows how mobile care models can reduce access barriers and strengthen preventive services in underserved communities. Read more here.
New Resource
Navigating the New CMS & CMMI Models
With multiple new CMS Innovation Center models launching at once, many organizations are facing real strategic choices about where to focus, how to align with existing contracts, and whether participation will advance long-term goals or add complexity. This new resource provides a structured way to compare models and evaluate fit, using a consistent decision framework across options such as AHEAD, ACCESS, ASM, BALANCE, LEAD, MAHA ELEVATE, and the Rural Health Transformation Program. It is designed to help providers, health systems, risk-bearing entities, technology partners, and states decide when it makes sense to apply directly, partner with others, or watch and prepare as the models evolve. Download here.
What We Are Reading
Spreading The Principles Of Palliative Care To All Corners
A Health Affairs Forefront piece highlights the growing integration of palliative care principles into broader clinical practice, emphasizing that these approaches to symptom management, communication, and holistic support should be extended beyond specialist settings to improve quality of life for people with serious illness at all stages. Read here.
New CMS Innovation Center Models on Prescription Drugs and Chronic Conditions: Key Information for State Medicaid Agencies
A Center for Health Care Strategies brief outlines key features of several new CMS Innovation Center models targeting prescription drug costs and chronic condition management and highlights considerations for state Medicaid agencies as they assess participation and implementation. Read here.
Progress Report: Psychiatric Collaborative Care Model (CoCM)
A recent analysis released by The Bowman Family Foundation and Shatterproof shows that use of the Psychiatric CoCM expanded dramatically from 2018–2024, integrating behavioral health into primary care more widely and demonstrating cost and outcome benefits, though adoption remains uneven across states largely due to gaps in Medicaid reimbursement. Read here.
What We're Attending
HCTTF Webinar: Driving Patient Affordability
Patient advocates and health system leaders will come together virtually on February 18 to explore how rising health care costs are affecting individuals and families. With voters ranking health care costs as a top concern, the discussion will focus on the real-world consequences of financial strain and highlight actionable strategies to reduce cost burdens for patients without compromising quality of care. Register here.
Accelerating Accountable Care Through Rapid Learning: Real-World Tests and Learning Collaboratives in Action
Hosted by the Duke Margolis Center for Health Policy, this event will explore how rapid-cycle learning and real-world tests can drive faster adoption and improvement of accountable care models. Participants will hear from policymakers, researchers, and provider leaders about emerging evidence, practical implementation lessons, and ways to strengthen collaboration between payers and health systems. The discussion aims to help organizations translate insights from real-world accountable care tests into actionable strategies that improve quality, lower cost, and support broader health system transformation. Register here.
Innovation in Behavioral Health (IBH) Model Cohort II Notice of Funding Opportunity (NOFO) Webinar
On March 5, 2026, the CMS Innovation Center will host a webinar providing an in-depth overview of the Innovation in Behavioral Health (IBH) Model’s Cohort II NOFO. The session will cover the model’s payment methodology, federal award details, and the application process for the seven-year voluntary model launching in January 2027, which aims to advance integrated, value-based care in specialty behavioral health settings across Medicaid and Medicare. Attendees will also hear from Cohort I state awardees, including Michigan, New York, and South Carolina, and participate in a live Q&A with the model team. Register here.
Pop Health Podcast
New Model Mania: Unpacking CMS's RHTP, ASM, LEAD, ACCESS, and ELEVATE
In the latest episode of the Pop Health Podcast, we break down CMS’s expanding portfolio of payment and delivery reform models, from the Rural Health Transformation Program and the Ambulatory Specialty Model to the new LEAD and ACCESS initiatives and the emerging ELEVATE framework, and discuss what these shifts mean for providers, payers, and health care leaders navigating value-based care in 2026 and beyond.