Health Equity & SDoH

CMS is pushing Medicaid value-based care further toward outcomes accountability, with 37 states joining a Trump administration initiative to streamline quality measurement around whether beneficiaries get healthier rather than whether plans and providers satisfy process-heavy reporting requirements—an important signal for Medicaid managed care plans, ACOs, and provider groups preparing for tighter alignment between quality, data infrastructure, and payment. At the same time, Medicaid ACO activity is becoming more targeted around equity-sensitive populations, especially maternal health, as Massachusetts Medicaid ACO initiatives and broader research on midwifery workforce authority point to care-model levers that can improve access and outcomes for high-risk pregnant members. The strategic tension for VBC stakeholders is that outcome-based Medicaid redesign is advancing alongside eligibility and coverage pressures—including community engagement/work requirements and legal immigrant coverage losses—which could destabilize attribution, continuity, and population health ROI unless plans and ACOs invest in enrollment retention, interoperability, and community-based care management (CMS/state Medicaid quality initiative; Massachusetts Medicaid ACO maternal health initiatives).