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CMS is adding value-based care (VBC) risk faster than many providers can build the data and tech capacity they need to succeed.
CMS is accelerating downside risk in value-based care (VBC), even though many clinicians, practices, and health systems lack the operational and measurement infrastructure needed to succeed. Misalignment between organizational readiness and VBC performance requirements is a significant reason VBC programs have produced mixed results.1,2 As risks increase, organizations at different levels of maturity must strengthen the executive, operational, and clinical capabilities needed for success.
Transition to New Models
Since July 2025, CMS and the Center for Medicare and Medicaid Innovation have announced several new models. Below are high-level summaries of 4 models chosen to illustrate key shifts in design, especially with respect to quality measures, financial performance expectations, and technology implementation: Advancing Chronic Care with Effective, Scalable Solutions Model (ACCESS),3 Ambulatory Speciality Model (ASM),4 Make American Health Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE),5 and Long-term Enhanced ACO Design Model (LEAD).
Many earlier VBC models had limited downside risk, allowing organizations to gain experience with care management, attribution, and performance measurement without major financial exposure. These models require or reward more advanced capabilities and different combinations of total-cost-of-care accountability, measurable quality performance, and longitudinal, condition-specific outcomes. Payment adjustments are increasingly tied to performance relative to benchmarks rather than to participation alone.