Value-based healthcare programs have been shifting provider’s payments from fee-for-service for more than a decade, rewarding providers who focus on patient outcomes rather than patient volume. Value-based healthcare programs are part of a larger long-term strategy to improve the way healthcare is delivered and paid for in the U.S., to improve patient outcomes, minimize growing costs and reduce unnecessary waste. The Centers for Medicare & Medicaid Services (CMS) and private insurers are pushing these models to help ease cost burdens for chronic conditions, which affects approximately 45% of people with Medicare and accounts for nearly 90% of total healthcare spending . Many chronic conditions such as diabetes, heart disease and obesity are preventable, or at least better managed with early intervention.
A new series of value-based care models was announced last month, each with its own unique approach to the shared underlying goal, which prioritizes prevention, promotes early intervention and encourages holistic care to reduce hospitalizations and complications.
1. MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-Based Approaches Through Evidence) Model
MAHA ELEVATE is the first model of its kind, offering a more holistic approach to care for traditional Medicare beneficiaries. It aims to address the root causes of chronic conditions, instead of just treating the symptoms of an existing condition. This model encourages healthier behaviors and lifestyle choices to prevent illness and build a healthier population. Primary areas of focus include nutrition, physical activity, sleep, stress management, harmful substance avoidance and social connection.
Payments: CMS will fund up to 30 cooperative agreements with a total budget of $100 million, over a 3-year performance period
Participants: Organizations that either provide whole-person functional or lifestyle medicine services directly to patients or partner with other organizations to deliver services, including:
Private medical practices
Health systems and accountable care organizations (ACOs)
Academic organizations
Functional, lifestyle, preventive and integrative medicine centers
Federally qualified health centers and rural health clinics
Community-based organizations
State or local governments
Indian health service/tribal services/urban Indian programs
Senior living communities
Requirements: Applicants must demonstrate that they (or their partners) are experienced in delivering these interventions (that are not already covered by original Medicare) and that the interventions are safe, effective and well-documented. Providers must be willing and able to collect, measure and report data to CMS.
Timing: CMS is expected to release a Notice of Funding Opportunity (NOFO) soon with details on the application process. Three-year cooperative agreements will be awarded in two rounds for two separate cohorts—one starting in 2026 and the second in 2027.
2. ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model
This voluntary model aims to give Medicare beneficiaries with qualifying chronic conditions including high blood pressure, diabetes, chronic musculoskeletal pain and depression (the four “tracks”) better access to technology to help manage their conditions. Using tools such as virtual visits, remote monitoring and artificial intelligence (AI)-assisted care to support patients beyond the doctor’s office, outcomes are rewarded when patients meet their health goals.
Payments: Using an Outcome-Aligned Payments (OAPs) approach, participating providers receive fixed payments tied to the clinical improvement or control of patient conditions over a 12-month period. The model will use clear success criteria based on each beneficiary’s baseline, offering full payment only if the beneficiary meets their target by the end of the care period.
Participants: Participating providers must be a Medicare Part B-enrolled organization in good standing that is eligible to bill under the Medicare Physician Fee Schedule (PFS) (excluding Durable Medical Equipment, Prosthetics, Orthotics and Supplies and laboratory suppliers). They must designate a Medicare-enrolled medical director to oversee care quality and compliance.
Requirements: ACCESS participants must adhere to Care Coordination Requirements which requires clinical updates be electronically shared with the beneficiaries’ primary care and referring care providers. They must meet minimum clinical outcome performance levels as defined in the participation agreement.
Timing: The 10-year model will run from July 5, 2026 (the first cohort) through June 30, 2036. Applications for the first performance period will be accepted through the CMS Participant Portal until April 1, 2026. Applications received after this date will be considered for a January 1, 2027 start, and quarterly thereafter through July 1, 2033.
3. TEAM (Transforming Episode Accountability Model)
This mandatory model applies to selected acute-care hospitals, requiring coordination of care for Medicare beneficiaries undergoing specific surgical procedures (lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedure). By increasing the support patients receive post-surgery and improving transitions between providers, the model aims to reduce costly hospital readmissions and improve long-term health.
Payments: TEAM is an episode-based payment approach that provides a calculated target price to cover all costs associated with a patient’s episode of care, which begins with a hospital inpatient stay or hospital outpatient procedure and ends 30 days after discharge. This includes costs associated with skilled nursing facility stays or provider follow-up visits. Target prices will be based on all Medicare Parts A & B items and services included in an episode, with risk-adjustments based on beneficiary-level and hospital-level factors. At performance year-end a reconciliation process will determine whether additional payments are warranted, if total episode spending is below the target price and quality thresholds are met.
Participants: Hospitals paid under the Inpatient Prospective Payment System (IPPS) and located in the selected Core-Based Statistical Areas (CBSAs) are required to participate in TEAM.
Requirements: Providers must establish accountable care relationships that connect patients to primary care services after discharge from any of the five specific surgical procedures. The model offers three participation tracks, each with varying levels of financial risk and reward.
Timing: This model will run for five performance years from January 1, 2026, to December 31, 2030, in selected Core-Based Statistical Areas nationwide.
4. LEAD (Long-term Enhanced ACO Design) Model
LEAD is a 10-year voluntary model that is designed to support established and new ACOs, with increasing scope to include smaller independent or rural-based practices. Succeeding the ACO REACH model that will end this year, it hopes to provide better care for high-needs patients, such as those dually eligible for Medicare and Medicaid, and those who are homebound or home limited.
Payments: Participating ACOs will choose from two risk-sharing options:
Global risk: ACOs may receive up to 100% of savings and are liable for up to 100% of total losses relative to their established benchmark
Professional risk: ACOs may receive up to 50% of savings and are liable for up to 50% of total losses relative to their established benchmark
Add-on payments may be offered to help providers build the infrastructure necessary to participate in an ACO. More information on risk adjustments and benchmarking will be announced.
Participants: This model is designed to appeal to a wider mix of providers, including those with specialized patient populations and those new to ACOs, such as smaller, independent or rural-based practices. Existing ACO REACH model participants are also likely to participate.
Requirements: Providers are incentivized to coordinate care, share data, prevent hospitalizations and keep patients healthy and engaged in their community.
Timing: This model is set to launch at the end of 2026. It will run for a span of 10 years, from January 1, 2027 through December 31, 2036. A request for applications will be made available for interested organizations in March 2026.
Leveraging Partnerships to Succeed with Value-Based Care
Value-based healthcare models are built on good intentions—to shift the focus of care from quantity to quality, creating a more sustainable healthcare system with the patient at the center. They are based on technology, innovation, transparency, and the continuous improvement of industry best practices. But the transition from traditional fee-for-service models requires significant changes in a provider’s infrastructure, policy, data management, payment models and mindset. Many providers lack the in-house resources that are necessary to successfully transition changes of this magnitude. By partnering with an experienced advisor such as Richter, your organization can feel confident in their ability to embrace value-based care models and all the benefits they offer. To learn more about our comprehensive solutions and how Richter can help your organization, contact us here or call us at 866.806.0799.
Richter partners exclusively with long-term post-acute care providers to deliver tailored, high-impact solutions across clinical, financial and operational domains. Our team of more than 90 healthcare consultants brings real world industry expertise to help leadership teams improve compliance, strengthen financial performance, optimize revenue cycle management, streamline EHR and PointClickCare systems and manage Medicaid eligibility with confidence. Acting as a trusted extension of your organization, we provide personalized guidance, expert-led enablement and end-to-end support that reduces complexity while driving measurable growth. With a focus on sustainable outcomes that strengthen clinical quality, financial stability and operational efficiency, while reducing risk and advancing resident care excellence, Richter empowers skilled nursing communities, senior living providers, home health and hospice organizations to achieve long-term success in today’s complex healthcare landscape.
