Payment Reform

CMS is accelerating a broader Trump administration payment-reform strategy that pairs mandatory or episode-based models with tech-enabled chronic-care experimentation: CJR-X would extend and expand joint-replacement bundles, while ACCESS is being positioned as a 10-year CMMI test for scalable, AI- and digitally enabled chronic condition management. The pattern is a tighter push toward measurable savings, prevention, and beneficiary choice under CMMI Director Abe Sutton’s “Make America Healthy Again” framework, creating opportunity for ACO enablement firms, tech-enabled plans, and specialty-care conveners—but also raising execution risks around attribution, benchmark design, downside risk, and provider readiness. For VBC stakeholders, the near-term signal is that CMS is not retreating from payment reform; it is shifting pressure toward condition- and episode-specific accountability across musculoskeletal and chronic-care populations, as reflected in the ACCESS rollout and CJR-X bundled-payment expansion.