Quality Metrics & Performance (MIPS/CMS)

In the past week, CMS has advanced two major policy proposals with significant implications for value-based care: the proposed national expansion of the Comprehensive Care for Joint Replacement (CJR-X) bundled payment model, which will require hospitals to take episode-based financial accountability for joint replacements across the entire care continuum, and the introduction of the LEAD Model as the next generation of Medicare ACOs, featuring locked-in historical benchmarks and expanded capitation with specialist risk-sharing. These developments underscore a clear policy shift toward broader mandatory risk and deeper integration of post-acute and specialist care into population health management frameworks, intensifying performance measurement pressures and data requirements for providers and ACOs aiming to succeed in the evolving value-based payment environment. For details, see summaries on the CJR-X bundled model and the LEAD ACO model.