CMMI Innovation Models

CMS/CMMI is signaling a more assertive, multi-year shift toward mandatory and longitudinal value-based models: LEAD would create a 10-year ACO pathway beginning in 2027 with applications due May 17, 2026, while CJR-X and related musculoskeletal episode concepts point to broader mandatory bundled-payment pressure around orthopedic spend. The strategic tension for ACOs, hospitals, and post-acute providers is whether to invest now in population health, home-based care, specialist alignment, and episode-management infrastructure—or risk being pulled into downside-risk models on CMS’s terms under the Trump administration’s current CMS leadership. For VBC stakeholders, the key read-through is that CMMI is moving beyond isolated demonstrations toward scaled model portfolios, but the Independence at Home experience underscores that even successful care-delivery models can face persistent scaling barriers around attribution, workforce, and operational replication (LEAD overview; [Independence at Home scaling issue](https://news.google.com/rss/articles/CBMixgFBVV95cUxQNmhmbTAxSDhmYjg0dkxWdFhYcjBwRzZkZU0tN1BWangzSEJMdUEzVmVwSGl0UnBKa24wbGdkeDBPRmUzblYyOTlo