Primary Care Models

CMS is increasingly becoming the primary engine for value-based care expansion as Medicare Advantage plans pull back on risk appetite and tighten utilization management, including elevated prior authorization denials; this shifts strategic focus for primary care, home-based care, and post-acute providers toward CMS/CMMI models rather than MA-only growth strategies. Primary care and in-home care organizations are positioning around models such as LEAD and TEAM to prove longitudinal, post-acute, and home-based care value, while NCQA’s HEDIS MY 2027 person-centered outcome measures and ECDS transition-of-care reporting signal that future VBC performance will depend more heavily on digital quality infrastructure and patient-defined goals. For ACOs, payers, and health systems, the near-term tension is whether CMS-led payment models can create enough predictable upside to offset MA retrenchment and administrative friction while accelerating care delivery transformation in primary care and the home (CMS as VBC engine; LEAD and in-home primary care).