MODEL DIRECTORY
Value-Based Care Models
Browse verified VBC programs sourced from CMS documentation. Each model includes implementation guidance, friction analysis, and organizational fit.
36 models available
ACCESS
Advancing Chronic Care with Effective, Scalable Solutions
The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) 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
ACO Primary Care Flex Model
The ACO Primary Care Flex (ACO PC Flex) Model is a 5-year voluntary model tested within the Medicare Shared Savings Program. It provides prospective payments and increased funding for primary care to empower ACOs to use innovative, team-based, and person-centered approaches. The model aims to improve health outcomes, quality, and costs of care for Medicare beneficiaries.
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, deliver coordinated care, improve health outcomes, and manage costs.
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 through primary care investment, hospital global budgets, and 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 glucagon-like peptide-1 (GLP-1) medications and healthy lifestyle interventions. CMS will negotiate drug pricing and coverage terms with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors.
BPCI Advanced
Bundled Payments for Care Improvement Advanced
The Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model tested voluntary episode-based payment across 29 inpatient, 3 outpatient, and 2 multi-setting clinical episode categories. The model ran from October 1, 2018 through December 31, 2025 and has now concluded.
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 whether a CMS-led approach to developing and administering outcomes-based agreements (OBAs) increases Medicaid beneficiaries' access to innovative treatments. 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 was a mandatory episode-based payment model for lower extremity joint replacement surgeries. It ran from April 2016 through December 31, 2024 and has now concluded.
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. It focuses on seven specific cancer types and aims to improve health outcomes 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 also provides additional support to health care providers treating dually eligible beneficiaries and those receiving the Low-Income Subsidy.
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 to Home Health Agencies based on their performance against a set of quality measures relative to their peers. The model builds on the original HHVBP Model to decrease unnecessary emergency room visits, improve patient mobility, and reduce Medicare spending.
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 focuses on Critical Access Hospitals (CAHs) to increase access to services like telehealth, nursing facility care, and ambulance services, with the goal of avoiding expensive transfers to larger communities.
Financial Alignment Initiative
Financial Alignment Initiative for Medicare-Medicaid Enrollees
The Financial Alignment Initiative is designed to provide individuals dually enrolled for Medicare and Medicaid with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs. Through the Initiative, CMS partners with states to test two new models for their effectiveness in accomplishing these goals.
GENEROUS
GENErating cost Reductions fOr U.S. Medicaid
The GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) 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 for drugs included in the model to align Medicaid net prices with what certain other countries pay.
GLOBE
Global Benchmark for Efficient Drug Pricing
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. It focuses on drugs administered in a clinical setting, such as cancer therapies or drugs used to treat autoimmune conditions and arthritis.
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 specialty behavioral health practices to provide whole-person, integrated care. It serves Medicaid, Medicare, and dually eligible beneficiaries with moderate to severe behavioral health conditions, aiming to better address their behavioral, mental, and physical health needs through a 'no wrong door' approach.
InCK
Integrated Care for Kids Model
The Integrated Care for Kids (InCK) Model gives states and local partners new tools to better coordinate care for children and families enrolled in Medicaid and CHIP. The model aims to meet physical, behavioral, and social needs 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) by incentivizing kidney transplant hospitals to improve their care delivery capabilities and efficiency. It supports greater care coordination and person-centeredness in the organ transplant waitlist process.
KCC
Kidney Care Choices (KCC) 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 a 10-year voluntary Accountable Care Organization (ACO) model launching in 2027. It utilizes improved benchmarking and a predictable window without rebasing to appeal to a broader mix of providers. The model focuses on delivering coordinated care for high-needs patients, including those dually eligible for Medicare and Medicaid or who are homebound.
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 aims to gather data on cost and quality to inform future interventions and reduce spending.
MD TCOC
Maryland Total Cost of Care Model
The Maryland Total Cost of Care (TCOC) Model partners with the state of Maryland to set a per capita limit on Medicare total cost of care. It builds upon the Maryland All-Payer Model to establish pricing across all payers and holds the state fully accountable for the cost and quality of care for Medicare patients. The model includes a Hospital Payment Program, a Care Redesign Program, and the Maryland Primary Care Program.
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. It is a one-year health behavior change educational program covered under Medicare Part B as a preventive service.
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.
Primary Care First
Primary Care First Model Options
Primary Care First is a voluntary alternative five-year payment model that rewards value and quality by offering an innovative payment structure to support the delivery of advanced primary care. The model tests whether delivery of advanced primary care can reduce total cost of care, accommodating practices at multiple stages of readiness to assume accountability for patient outcomes.
RCHD
Rural Community Hospital Demonstration
The Rural Community Hospital Demonstration (RCHD) tests cost-based reimbursement for small rural hospitals with fewer than 51 beds. It targets hospitals that do not qualify for Critical Access Hospital (CAH) designation. The model aims to increase financial viability and capacity within rural communities.
RO Model
Radiation Oncology Model
The Radiation Oncology (RO) Model was designed as a mandatory episode-based payment model for radiotherapy services. It has been indefinitely delayed through federal rulemaking and does not currently have a confirmed start date.
RSNAT Prior Authorization
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT)
The RSNAT Prior Authorization model helps ambulance suppliers ensure their services comply with Medicare coverage, coding, and payment rules before services are rendered. It requires the same documentation as standard Medicare payment, but earlier in the process. This allows suppliers to address claim issues proactively, potentially reducing appeals for denied claims.
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 from surgery through recovery by supporting the coordination and transition of care between providers.
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
The Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model tests a broad array of MA health plan innovations. It aims to enhance the quality of care for Medicare enrollees, including those with low income, and reduce costs. Participating MA plans may provide tailored supplemental benefits such as lower costs for prescription drugs, grocery assistance, and transportation services.
Vermont All-Payer ACO
Vermont All-Payer Accountable Care Organization (ACO) Model
The Vermont All-Payer Accountable Care Organization (ACO) Model is a CMS test of an alternative payment model across Medicare, Medicaid, and commercial health payers in Vermont. It incentivizes health care value and quality under the same payment structure for the majority of providers throughout the state. The model aims to transform health care for the entire state and its population by focusing on health outcomes rather than the volume of services provided.
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.