CMMI Models

CMMI model activity is drawing sharper scrutiny as stakeholders weigh operational upside against beneficiary-access and administrative-risk concerns: Interwell Health is pointing to savings and high quality scores in Kidney Care Choices while a kidney-care coalition is pressing CMS for a longer-term accountable kidney model, signaling continued provider appetite for specialty VBC beyond current demonstrations. At the same time, Democrats are demanding more transparency on CMS’ WISeR Medicare AI prior authorization pilot amid concerns about delayed care, and physician groups are preparing for Medicare’s new ACCESS primary care model—suggesting the Trump CMS under Dr. Mehmet Oz and CMMI Director Abe Sutton is facing pressure to balance model innovation, technology-enabled utilization management, and provider participation burden. Hospitals also face near-term execution risk as TEAM and CJR-X raise the stakes for coding, utilization review, and physician-advisor workflows tied to episode-based payment. Kidney model momentum