CMMI Models

CMMI’s center of gravity continues to shift toward provider-led VBC infrastructure: the TEAM episode-based payment model is being framed as a test of whether home health and post-acute partners can measurably reduce avoidable institutional utilization after surgery, even as CMS becomes a more important VBC catalyst while some Medicare Advantage plans pull back from provider enablement. Medicaid VBC is also expanding into more complex population-health use cases, with Indiana moving to cover GLP-1 obesity drugs through the federal BALANCE model and Medicaid ACO leaders emphasizing maternal-health quality improvement as a proving ground for care coordination, data sharing, and accountability across fragmented safety-net systems. For ACOs, health systems, and payers, the week’s throughline is that federal models are increasingly being used to force operating discipline around specialty episodes, pharmacy-cost risk, and high-need populations—not just broad total-cost-of-care participation (TEAM/post-acute analysis; Medicaid ACO maternal health analysis).