Medicare Payment Policy

CMS is signaling a more aggressive Medicare payment-policy pivot toward accountable care: ACO REACH produced $988 million in Medicare savings in 2024 before its scheduled sunset, while organizations are weighing LEAD versus MSSP participation as CMS prepares financial-methodology details and proposed physician payment reforms that would expand ACO participation and move away from MIPS. The strategic tension for VBC stakeholders is whether the Trump administration under CMS Administrator Dr. Mehmet Oz and CMMI Director Abe Sutton will preserve REACH-like risk arrangements through LEAD/MSSP redesign or replace them with tighter guardrails, especially as Medicare Advantage coding intensity and CMMI Trust Fund payment transparency remain under scrutiny. For ACOs, physician groups, and payers, the near-term priority is positioning around downside-risk readiness, participant TIN strategy, benchmark exposure, and model optionality before final CMS rules and LEAD decisions land (ACO REACH savings; LEAD risk mitigation).