CMMI Innovation Models

CMMI’s portfolio is moving toward more condition- and site-specific accountability: LEAD is being positioned as a successor to REACH for longitudinal, in-home primary care with a defined role for home health agencies, while CMS is refining the Ambulatory Specialty Model for heart failure and stakeholders are already preparing for CJR-X’s 2028 mandatory episode-payment expansion. The strategic through-line is tighter integration across primary care, specialty care, post-acute providers, and hospitals—but with growing scrutiny on whether technology-enabled care management actually produces savings, as recent virtual CKD assessments question ROI and push VBC leaders toward earlier diagnosis, risk stratification, and evidence-backed interventions. For ACOs, health systems, and payers, the near-term opportunity is to align home-based care, specialty episodes, and population health infrastructure before model participation requirements and downside-risk exposure become more prescriptive under the Trump administration’s CMS/CMMI leadership; see coverage of the LEAD model’s home health role and Premier’s analysis of CJR-X readiness.