Recently, the Centers for Medicare & Medicaid Services has accelerated a fundamental redesign of Medicare value-based care through a new wave of models that are reshaping how organizations manage surgical episodes, chronic conditions, ambulatory specialty care, and population health. This transformation extends beyond hospitals and health systems, impacting physician groups, specialists, post-acute providers, and community-based organizations that are increasingly expected to participate in coordinated, outcomes-focused care delivery. As these CMS programs move from announcement to implementation, they reinforce a clear shift away from volume-based care toward models that reward organizations for proactively managing cost, quality, and patient outcomes across the full continuum of care.
While each model targets a different area of care delivery, treating them as four separate regulatory initiatives misses the bigger picture. On paper, these models look distinct, but underneath, CMS is pushing organizations toward the same core capabilities: real-time visibility into patient risk and performance, tighter coordination across care settings, workflows built to act on insights before problems compound, and a sustained focus on patient satisfaction and experience. Understanding each model’s individual requirements still matters, but treating any one of them as an isolated compliance exercise risks missing capabilities that carry over to whatever comes next. Organizations that build shared infrastructure now will be far better positioned to perform under the models relevant to them, not just comply.
Episode-Based Payment Models: TEAM and CJR-X
This shift is particularly evident in CMS’s Transforming Episode Accountability Model (TEAM), a mandatory five-year episode-based payment model that began January 1, 2026, and will run through December 31, 2030. TEAM requires selected acute care hospitals in designated geographic areas to participate and assume accountability for defined surgical episodes, including total cost, quality outcomes, and patient experience from the index procedure through the 30-day post-discharge period. As organizations continue implementing TEAM, success will require moving beyond traditional episode management and adopting a proactive, data-driven approach to care delivery. Organizations must develop standardized clinical workflows, establish and manage preferred post-acute care networks, strengthen care coordination across the continuum, and maintain visibility into performance against episode target prices, cost drivers, utilization patterns, and patient outcomes.
Real-time visibility following discharge is critical, as organizations must quickly identify patients at increased risk for complications, readmissions, and/or avoidable utilization. Leveraging predictive analytics, including AI-driven models that identify high-risk patients, enables care teams to intervene earlier, close care gaps, and better coordinate resources across the care continuum. The workflows, data capabilities, preferred PAC partnerships, and cross-functional care management processes organizations build through TEAM will also serve as a foundation for future episode-based models, including CJR-X.
Looking ahead, CMS has finalized the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, an extension of the original CJR Model, as a mandatory, nationwide episode-based payment program for lower-extremity joint replacements beginning January 1, 2028. CJR-X extends accountability for cost and quality from the index inpatient or outpatient joint procedure through 90 days post-discharge, including post-acute care and readmissions, making integrated episode management a core operating requirement for participants.
CJR-X builds directly on a framework CMS has already demonstrated results. The original CJR Model ran from 2016 through its conclusion on December 31, 2024, and in its final two performance years alone, CMS reported $112.7 million in net Medicare savings across 323 participating hospitals, while key quality outcomes remained stable. CJR-X carries that same proven foundation forward, now on a nationwide scale.
The same operational foundation extends beyond episode-based care. As CMS advances accountability through TEAM and CJR-X, it is also introducing new accountable care models.
Long-Term Accountable Care: LEAD
The Long-term Enhanced ACO Design (LEAD) Model is a new 10-year voluntary value-based care model that launches on January 1, 2027, replacing ACO REACH. The model is designed to expand participation in accountable care while providing greater long-term stability for organizations. It introduces new approaches that improve financial sustainability and support better outcomes for high-needs and dually eligible populations. Running through December 31, 2036, LEAD reflects CMS’s continued commitment to advancing value-based care.
Success in LEAD will require organizations to move beyond traditional care management and build a sustainable, value-based operating model that can perform over a 10-year period. Organizations will need to effectively manage higher-risk, dually eligible, and underserved populations while maintaining strong quality performance and controlling total cost of care. Success will depend on strengthening primary care, integrating specialty providers into value-based care, improving risk stratification and beneficiary engagement, and using data-driven insights to identify intervention opportunities earlier. Just as important, organizations will need the financial and operational flexibility to adapt as benchmarks, payment methodologies, and CMS priorities evolve over the life of the model. Those that invest in scalable care models, provider alignment, advanced analytics, and longitudinal population health strategies will be best positioned to succeed.
The same pattern continues with ACCESS. While LEAD focuses on long-term accountability across patient populations, ACCESS extends CMS’s value-based care strategy into technology-supported chronic disease management.
Technology-Enabled Chronic Care: ACCESS
The Advancing Chronic Care with Effective and Scalable Solutions (ACCESS) Model is a 10-year voluntary value-based care model that focuses on expanding technology-supported care for Medicare beneficiaries with chronic conditions. Through Outcome-Aligned Payments (OAPs), the model ties reimbursement to measurable patient outcomes rather than the volume of services delivered, while supporting clinician-guided, coordinated care.
ACCESS launched in July 2026 with four initial clinical tracks spanning cardio-kidney-metabolic conditions, musculoskeletal pain, and behavioral health. CMS has already expanded the model’s scope, announcing that new tracks for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorder, and tobacco cessation, along with a follow-on period for chronic musculoskeletal pain, will begin April 1, 2027.
To be successful, organizations participating in the model will need to move beyond simply deploying digital health tools and focus on how those technologies support measurable improvements in care. Organizations will need the capabilities to integrate technology into clinical workflows, measure and improve patient outcomes, coordinate care across providers, and manage chronic conditions longitudinally to perform effectively under the model. The model’s expansion reinforces the value of building adaptable infrastructure that can support new conditions and evolving requirements over time.
Taken together, TEAM, CJR-X, LEAD, and ACCESS should not be viewed simply as four separate CMS programs requiring four separate responses. They point to a common operating model for the next generation of value-based care, built around earlier identification of risk, connected clinical workflows, stronger coordination across settings, longitudinal patient engagement, and the ability to proactively turn data into action.
As accountability continues to expand across episodes, populations, and chronic care, organizations that build these capabilities as shared infrastructure rather than model-specific solutions will be better positioned not only to perform under today’s programs, but to adapt as CMS continues to advance value-based care.
