Quality Metrics & Stars

CMS is pushing quality measurement deeper into payment design by pairing outcome-tied chronic care payments in the ACCESS model with broader episode/accountable care expansion: ACCESS accepted 150 participants for a July launch, tying Medicare payments for obesity, diabetes, MSK pain, and depression interventions to measurable results enabled by digital health partners. At the same time, CMS is signaling a harder shift from voluntary pilots to mandatory or structurally durable risk—most notably the proposed nationwide CJR-X joint replacement bundle beginning in 2027 and the emerging LEAD ACO model framework with longer-term benchmarking and expanded capitation—raising the stakes for hospitals, ACOs, specialists, home health, and tech vendors to prove quality performance while managing total cost of care. For VBC leaders, the strategic tension is clear: CMS wants scalable quality-and-outcomes accountability, but payment levels, mandatory participation, partner attribution, and post-acute coordination requirements will determine whether these models accelerate sustainable transformation or simply compress margins under new Stars- and quality-like performance pressure (ACCESS participants; CJR-X proposal).