MODEL DIRECTORY
Value-Based Care Models
Browse verified VBC programs sourced from official program documentation. Each model includes implementation guidance, friction analysis, and organizational fit.
39 models available
ACCESS
Advancing Chronic Care with Effective, Scalable Solutions
The ACCESS Model is a 10-year national test of a new payment approach designed to expand access to technology-supported care for people with chronic conditions. It provides participating organizations with predictable, recurring payments for helping patients manage qualifying chronic conditions, with full payment depending on achieving measurable health outcomes.
ACO PC Flex
Accountable Care Organization Primary Care Flex Model
The ACO Primary Care Flex (ACO PC Flex) Model tests how prospective payments and increased funding for primary care in Accountable Care Organizations (ACOs) effects health outcomes, quality, and costs of care within the Medicare Shared Savings Program. The voluntary model started January 1, 2025, and runs through 2029.
ACO REACH
ACO REACH Model
The ACO REACH Model provides novel tools and resources for health care providers to work together in an Accountable Care Organization (ACO) to improve the quality of care for people with Original Medicare. Redesigned from the Global and Professional Direct Contracting (GPDC) Model, it encourages providers to break down silos and deliver high-quality, coordinated care.
AHEAD
Achieving Healthcare Efficiency through Accountable Design
AHEAD is a voluntary state total cost of care (TCOC) model that aims to drive state and sub-state-regional health care transformation and multi-payer alignment. It seeks to improve the total health of a state’s population while lowering costs by investing in primary care, implementing hospital global budgets, and utilizing geographic ACO entities.
ASM
Ambulatory Specialty Model
The Ambulatory Specialty Model (ASM) aims to improve prevention and upstream management of chronic disease, which would lead to reductions in avoidable hospitalizations and unnecessary procedures. Participation in ASM will be mandatory for specialists who commonly treat people with Original Medicare for heart failure or low back pain in an outpatient setting across selected regions.
BALANCE
Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth
The BALANCE Model aims to increase access to select GLP-1 medications and healthy lifestyle interventions for people with Medicare and Medicaid. CMS will negotiate drug pricing and coverage terms directly with manufacturers on behalf of state Medicaid agencies and Medicare Part D plan sponsors.
BPCI Advanced
Bundled Payments for Care Improvement Advanced
The BPCI Advanced Model is a voluntary episode payment model that bundles the costs of care provided to a Medicare beneficiary during a 90-day Clinical Episode into a single payment. It aims to support healthcare providers who invest in practice innovation and care redesign to better coordinate care, reduce expenditures, and improve quality. Providers become the accountable party in this total cost of care approach, facilitating coordination among the entire health care team.
CGT Access Model
Cell and Gene Therapy Access Model
The Cell and Gene Therapy (CGT) Access Model is a multi-year, voluntary model for states and manufacturers to test outcomes-based agreements for cell and gene therapies. It aims to increase Medicaid beneficiaries' access to innovative treatments, improve health outcomes, and reduce health care costs and burden to state Medicaid programs. The initial focus is on gene therapy treatments for sickle cell disease.
CJR
Comprehensive Care for Joint Replacement Model
The Comprehensive Care for Joint Replacement (CJR) Model is a retrospective bundled payment model designed to improve care for Medicare patients undergoing hip, knee, and ankle replacements. It incentivizes hospitals, physicians, and post-acute care providers to work together to improve quality and coordinate care from the initial procedure through a 90-day recovery period.
Community Supports (CalAIM)
CalAIM Community Supports
Community Supports are services that help improve the health and well-being of Medi-Cal Managed Care Plan (MCP) Members by addressing health-related social needs. They serve as cost-effective, medically appropriate alternatives to traditional medical services or settings, such as hospitals or nursing facilities. The model includes 14 pre-approved services, such as housing transition, medically tailored meals, and respite care, which MCPs can optionally offer to their members.
Enhanced Care Management (ECM)
Enhanced Care Management
Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of Medi-Cal members with the most complex medical and social needs. It provides systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered.
EOM
Enhancing Oncology Model
The Enhancing Oncology Model (EOM) is a nationwide voluntary payment model that incentivizes oncology practices to deliver coordinated, high-quality, patient-centered care for Medicare beneficiaries receiving systemic chemotherapy for seven specific cancers. The model aims to improve health outcomes and patient experiences while reducing Medicare spending.
ETC
End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model
The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model is a mandatory model intended to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD. It aims to reduce Medicare expenditures while preserving or enhancing the quality of care. The model provides additional support to health care providers treating dually eligible beneficiaries and those receiving Low-Income Subsidy assistance.
Expanded HHVBP
Expanded Home Health Value-Based Purchasing Model
The Expanded Home Health Value-Based Purchasing (HHVBP) Model seeks to improve the quality and efficiency of home health care across the nation. It adjusts Medicare fee-for-service payments for Home Health Agencies based on their performance against a set of quality measures relative to their peers. The model aims to improve patients' experience, strengthen physical function, and address health issues before they require an emergency room visit.
FCHIP
Frontier Community Health Integration Project Demonstration
The Frontier Community Health Integration Project Demonstration aims to develop and test new models of integrated, coordinated health care in the most sparsely-populated rural counties. It utilizes Critical Access Hospitals (CAHs) to increase access to services like telehealth, nursing facility care, and ambulance services to avoid expensive transfers.
Financial Alignment Initiative
Financial Alignment Initiative for Medicare-Medicaid Enrollees
The Financial Alignment Initiative is designed to provide individuals dually enrolled in Medicare and Medicaid with a better care experience and to better align the financial incentives of both programs. CMS partners with states to test two models: a Capitated Model and a Managed Fee-for-Service Model. These models aim to integrate primary, acute, behavioral health, and long-term services and supports.
GENEROUS
GENErating cost Reductions fOr U.S. Medicaid
The GENEROUS Model aims to ensure fair and reasonable drug prices for Medicaid through CMS-led negotiations with drug manufacturers. Under the model, manufacturers will provide supplemental rebates to participating states to align Medicaid net prices with what certain other countries pay.
GLOBE
Global Benchmark for Efficient Drug Pricing Model
The Global Benchmark for Efficient Drug Pricing (GLOBE) Model is a proposed mandatory model that would assess a rebate for certain drugs payable under Medicare Part B if the prices exceed those paid in economically comparable countries. CMS expects GLOBE would reduce out-of-pocket drug costs for people with Medicare and result in savings to Medicare while preserving or enhancing beneficiaries’ quality of care.
GUARD
Guarding U.S. Medicare Against Rising Drug Costs
The Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model is a proposed mandatory model that would assess rebates for certain drugs payable under Medicare Part D if the prices exceed those paid in economically comparable countries. CMS expects GUARD would reduce out-of-pocket drug costs for people with Medicare and result in savings to Medicare while preserving or enhancing beneficiaries’ quality of care.
GUIDE
Guiding an Improved Dementia Experience Model
The GUIDE Model is a voluntary, nationwide model testing the impact of providing comprehensive services and supports for people with dementia and their caregivers. It advances coordinated dementia care by providing evidence-based services including care navigation, 24/7 support, caregiver training, and respite services.
IBH
Innovation in Behavioral Health Model
The Innovation in Behavioral Health (IBH) Model is a state-based model that leverages patients' relationships with specialty behavioral health practices to provide whole-person, integrated care. It aligns Medicaid and Medicare to better address behavioral, mental, and physical health for adults with moderate to severe mental health conditions or substance use disorders.
InCK
Integrated Care for Kids Model
The Integrated Care for Kids (InCK) Model gives states and local partners new tools to better coordinate care to meet the physical, behavioral, and social needs of children and families enrolled in Medicaid and CHIP. The model aims to help kids stay healthy, supported, and at home.
IOTA
Increasing Organ Transplant Access Model
The Increasing Organ Transplant Access (IOTA) Model aims to increase access to life-saving kidney transplants for patients living with end-stage renal disease (ESRD). It incentivizes kidney transplant hospitals to improve their care delivery capabilities and efficiency, and supports greater care coordination in the organ transplant waitlist process.
KCC
Kidney Care Choices Model
The Kidney Care Choices (KCC) Model aims to delay the onset of dialysis and incentivize kidney transplantation for people with Medicare who have chronic kidney disease (CKD) stages 4 and 5 and end-stage renal disease (ESRD). The voluntary model launched in 2022 and will run through 2027.
LEAD
Long-term Enhanced ACO Design Model
The Long-term Enhanced ACO Design (LEAD) Model is the Innovation Center’s newest Accountable Care Organization (ACO) focused model, set to launch following the conclusion of ACO REACH at the end of 2026. It utilizes improved benchmarking to appeal to a broader mix of health care providers, including those with specialized patient populations and those new to ACOs. With a 10-year performance period, LEAD offers a predictable window without rebasing and a pathway toward sustainable long-term benchmarks and savings.
MAHA ELEVATE
Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence
The MAHA ELEVATE Model provides approximately $100 million to fund 3-year cooperative agreements for up to 30 proposals promoting health and prevention for Original Medicare beneficiaries. It utilizes evidence-based, whole-person care approaches, including functional or lifestyle medicine interventions, to support conventional medical care. The model gathers data on cost and quality to inform future interventions and reduce spending.
Maryland TCOC
Maryland Total Cost of Care Model
The Maryland Total Cost of Care (TCOC) Model sets a per capita limit on Medicare total cost of care in Maryland. It builds upon the Maryland All-Payer Model to establish pricing of medical services across all payers. The model promotes greater coordination between health care providers and patient-centered care to improve health outcomes and reduce avoidable hospitalizations.
MDPP Expanded Model
Medicare Diabetes Prevention Program (MDPP) Expanded Model
The Medicare Diabetes Prevention Program (MDPP) Expanded Model is an evidence-based behavior change intervention to delay or prevent the onset of type 2 diabetes among people with Medicare. This voluntary model was certified for expansion in 2016 and is covered under Medicare Part B as a preventive service.
MSSP
Medicare Shared Savings Program
Medicare Shared Savings Program (Shared Savings Program) ACOs are groups of doctors, hospitals, and other health care providers who collaborate to give coordinated high-quality care to people with Medicare. They focus on delivering the right care at the right time, while avoiding unnecessary services and medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program.
PARHM
Pennsylvania Rural Health Model
The Pennsylvania Rural Health Model (PARHM) pays participating rural hospitals a fixed amount upfront, regardless of patient volume. This global budget empowers hospitals to invest in high-quality primary and specialty care tailored to their communities. The model aims to improve the financial viability of rural hospitals, enhance health outcomes, and maintain access to care for rural residents.
Primary Care First
Primary Care First Model Options
Primary Care First was a voluntary alternative five-year payment model that rewarded value and quality by offering an innovative payment structure to support the delivery of advanced primary care. It prioritized the clinician-patient relationship, enhanced care for patients with complex chronic needs, and focused financial incentives on improved health outcomes.
RCHD
Rural Community Hospital Demonstration
The Rural Community Hospital Demonstration tests cost-based reimbursement for covered Medicare inpatient hospital services paid to small rural hospitals with fewer than 51 beds. It aims to increase financial viability for hospitals that are too large to qualify for Critical Access Hospital (CAH) designation.
RO Model
Radiation Oncology Model
The Radiation Oncology (RO) Model aims to improve the quality of care for cancer patients receiving radiotherapy (RT) and move toward a simplified and predictable payment system. The model tests whether prospective, site-neutral, modality-agnostic, episode-based payments reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.
RSNAT Prior Authorization
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
The RSNAT Prior Authorization model allows ambulance suppliers to ensure their services comply with Medicare rules before rendering services and submitting claims. While voluntary, bypassing prior authorization subjects claims to prepayment medical review. The model aims to reduce appeals and Medicare spending while maintaining quality of care.
TEAM
Transforming Episode Accountability Model
In the Transforming Episode Accountability Model (TEAM), selected acute care hospitals coordinate care from surgery through 30 days post-hospitalization for people with Original Medicare undergoing one of five surgical procedures. The model aims to improve the patient experience and reduce avoidable readmissions and emergency department use.
TMaH
Transforming Maternal Health Model
The Transforming Maternal Health (TMaH) Model supports participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care. By addressing the physical, mental health, and social needs experienced during pregnancy, the model aims to improve outcomes and experiences for mothers and babies, while also reducing overall program expenditures.
VBID
Medicare Advantage Value-Based Insurance Design Model
Through the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model, CMS tested a broad array of MA health plan innovations. These innovations aimed to enhance the quality of care for Medicare enrollees, including those with low income, and reduce costs for enrollees and the overall Medicare program. The model allowed participating MAOs to further target benefit design to enrollees based on chronic health conditions, Low-Income Subsidy eligibility, or place of residence.
Vermont All-Payer ACO
Vermont All-Payer Accountable Care Organization (ACO) Model
The Vermont All-Payer ACO Model is a CMS test of an alternative payment model across Medicare, Medicaid, and commercial payers in Vermont. It incentivizes health care value and quality, focusing on health outcomes under the same payment structure for the majority of providers throughout the state. The model aims to redesign the entire care delivery system and transform health care for the entire state population.
WISeR
Wasteful and Inappropriate Service Reduction (WISeR) Model
The Wasteful and Inappropriate Service Reduction (WISeR) Model helps protect American taxpayers by leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services. The voluntary model encourages care navigation, encouraging safe and evidence-supported best practices for treating people with Medicare.