CMMI releases nine new payment models

The Center for Medicare & Medicaid Innovation (CMMI) released nine new value-based payment models in the final weeks of 2025. The models highlight CMMI’s focus on whole-person and lifestyle care and its desire to expand participation to more types of health care organizations. Primary care practices will have opportunities to participate directly or indirectly. While there are still many details yet to be released, the AAFP has provided a brief overview of each model below and will follow up as we learn more.

Model: MAHA ELEVATE

Who might be interested: Practices that provide whole-person functional or lifestyle medicine services that are not currently covered by traditional Medicare.

Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) is a voluntary model that aims to support evidence-based, whole-person approaches that are not currently covered by traditional Medicare, including functional or lifestyle medicine interventions. The three-year model will provide a total of approximately $100 million through cooperative agreements to up to 30 organizations that provide whole-person functional or lifestyle medicine services directly to patients or through partnership with other organizations. Eligible recipients include private practices, health systems and accountable care organizations, Federally Qualified Health Centers and Rural Health Clinics, community-based organizations, functional/lifestyle medicine centers, and similar entities.

Recipients will select which chronic conditions to target and which interventions to use, but all proposals must incorporate nutrition or physical activity. The Centers for Medicare & Medicaid Services (CMS) will reserve three awards for interventions that address dementia. Recipients can use the funds for administrative and data reporting costs as well as patient care.

CMS will award cooperative agreements in two rounds — the first cohort will be awarded Sept. 1, 2026, and the second in 2027. Additional information will be available in a forthcoming Notice of Funding Opportunity (NOFO).

Model: LEAD

Who might be interested: Accountable Care Organizations (ACOs) that participate in Realizing Equity, Access, and Community Health (REACH) and practices interested in joining an ACO model that offers prospective payments and opportunities to offer innovative beneficiary enhancements.

Long-term Enhanced ACO Design (LEAD)  is a new voluntary ACO model set to launch after ACO REACH concludes at the end of 2026. LEAD is designed to expand opportunities for health care professionals who have been unable to participate in previous models — particularly those in small or rural settings and those who serve high-need populations. The model will offer improved benchmarks, prospective payments, and opportunities for participants to offer benefit enhancements and beneficiary engagement incentives. LEAD also aims to incorporate more specialists by introducing a new framework to allow ACOs to develop episode-based risk arrangements with their specialists and other health care organizations.

As with ACO REACH, LEAD will offer two voluntary risk-sharing options:

1. Global risk track: participants eligible to receive up to 100% of total savings and liable for up to 100% of total losses,
2. Professional risk track: participants eligible to receive up to 50% of total savings and liable for up to 50% of total losses.

LEAD is a 10-year model that will run from Jan. 1, 2027, through Dec. 31, 2036. CMS will release a request for applications in March 2026.

Model: ACCESS

Who might be interested: Organizations that provide technology-supported chronic care services and practices using advanced technological capabilities to address chronic conditions.

The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model is designed to expand access to technology-supported care for common chronic conditions. The program will issue payments for managing qualifying conditions that will be tied to outcomes rather than a defined set or volume of services. Participants will include Medicare Part B-enrolled clinicians and suppliers who deliver technology-supported chronic care services. Examples of services include clinical consultations, lifestyle and behavioral support, therapy and counseling, patient education and care coordination, and medication management. Participants may provide care in person, virtually, asynchronously, or through other technology-enabled methods.

While most primary care practices may not enter the ACCESS model as participants, physicians, other clinicians, and their patients can benefit by referring patients to ACCESS participants. Once patients are enrolled, the ACCESS participant will send regular updates on the patient’s progress to their primary care and/or referring clinicians. Primary care and referring clinicians will also be eligible to bill for reviewing these updates and coordinating associated care. This new co-management payment will be approximately $30 and can be reported once every four months, up to $100. It is not subject to beneficiary cost-sharing.

The ACCESS model will launch July 6, 2026, and run through June 30, 2036. Additional information is available in the Request for Applications and the AAFP News site. Applications opened Jan. 12, and those received by April 1 will be considered for the model’s first performance year, which begins July 5. Applications received after April 1 will be eligible to start Jan. 1, 2027. CMS will continue to accept applications on a rolling basis through April 1, 2033.

Prescription drug models

CMMI also announced four models aimed at lowering prescription drug costs for Medicare and Medicaid beneficiaries. The start dates and duration have not been announced for these models:

• Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE), a voluntary model under which CMS negotiates pricing and coverage terms with manufacturers of GLP-1 weight-management and metabolic health drugs,
• Guarding U.S. Medicare Against Rising Drug Costs (GUARD), a mandatory model that would assess Most-Favored-Nation (MFN)-based rebates in Medicare Part D when U.S. prices exceed international reference prices,
• Global Benchmarking for Efficient Pricing (GLOBE), a mandatory model that would assess MFN-based rebates in Medicare Part B by replacing domestic inflation-based rebate benchmarks with international pricing comparisons,
• GENErating cost Reductions fOr U.S. Medicaid (GENEROUS), a voluntary Medicaid MFN-based pricing model intended to secure lower drug costs by tying rebates to international drug price benchmarks.

Other models

Two other new CMMI models are likely to have less impact on family physicians:

• Wasteful and Inappropriate Service Reduction (WISeR) focuses on using technology-enabled prior authorization and pre-payment review for skin and tissue substitutes, implantation of electrical nerve stimulators, and knee arthroscopy for knee osteoarthritis. It is being tested in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
• Ambulatory Specialty Model (ASM) is mandatory for outpatient specialists treating heart failure or low-back pain including specialists in cardiology, anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, and physical medicine and rehabilitation. The model will start Jan. 1, 2027, and is focused on specific geographic areas that can be found in ASM Mandatory Geographic Areas (Excel file). Participants will be required to establish collaborative agreements with their patients’ primary care clinicians.

The AAFP will continue to review and provide additional insights for each model as more details are released. Visit the AAFP’s CMMI webpage to stay updated.

— Erin Solis, Manager, Practice & Payment at the American Academy of Family Physicians

Posted on Jan. 15, 2026