Quality Metrics & MIPS/CMS

Over the last week, CMS has accelerated a dual-track strategy for value-based care by both broadening episode-based mandatory bundled payments and deepening technology-driven, outcome-based chronic care models. The proposed nationwide, mandatory CJR-X model would require hospitals to manage Medicare spending for joint replacements, extending bundled payments and care accountability to knee, hip, and ankle procedures as of October 2027, raising the stakes for hospital-led population health management and cross-setting coordination (CMS proposes mandatory hospital-bundled model for joint replacements). Simultaneously, CMS has greenlit over 150 digital health companies, ACOs, and provider organizations for its new ACCESS model, which tests leaner payment rates and voluntary participation while linking reimbursement for chronic care—including obesity, diabetes, and depression—to measurable health outcomes supported by technology (CMS announces 150 participants for upcoming ACCESS model launch). These developments signal a shift toward greater payer control and data-driven oversight, intensifying operational pressures and incentives for providers, digital health partners, and care delivery networks under CMS’s evolving quality metrics and performance frameworks.