In 2025, the Center for Medicare and Medicaid Innovation (CMMI), also known as the CMS (Centers for Medicare & Medicaid Services) Innovation Center, launched a patchwork of new value-based payment (VBP) models that stand to drastically reshape the long term care sector. The new models—eleven in total—represent one prong of the federal government’s broader effort to move away from fee-for-service (FFS) care toward reimbursement frameworks that reward providers for improved clinical outcomes and a higher quality of care, holding stakeholders across the care spectrum accountable for the entire beneficiary journey.
The Most Important New Models for Long Term Care Providers
Not all new models affect long term care providers, but a few are especially relevant, and one has already gone into effect.
TEAM
The Transforming Episode Accountability Model (TEAM), which launched January 1, 2026, is a mandatory bundled payment model for hospitals in certain Core-Based Statistical Areas. It makes hospitals accountable for the total cost and quality of care—including associated skilled nursing facility (SNF) stays—for thirty-day surgical episodes in connection with five surgeries: lower extremity joint replacements, surgical hip femur fracture treatments, spinal fusions, coronary artery bypass grafts, and major bowel procedures. The model allows participants (hospitals) to make financial arrangements with “collaborators” (such as SNFs and post-acute care providers) to coordinate care and share in the final reconciliation payment at the end of the year.
LEAD
Then there’s the Long-Term Enhanced ACO Design (LEAD) model, a voluntary ten-year model launching in 2027 that is expected to replace ACO REACH. Like its predecessor, LEAD aims to give providers a stable, long-term incentive to deliver evidence-based preventive care, especially to complex and dual-eligible populations, including patients with specialized needs. As CMS has explained, LEAD is also designed with a particular focus on “independent physician-led practices” and those in rural areas. In order to enhance participation from these provider types, LEAD offers additional capitated payment structures, more predictable benchmarking, enhanced beneficiary engagement incentives, and accountability for total cost and quality outcomes. CMS has indicated that LEAD will continue important protections for high‑risk beneficiaries, such as concurrent risk adjustment, and will avoid benchmark rebasing or ratchet effects.
Nisha Hammel, vice president of reimbursement policy and population health at the American Health Care Association (AHCA), noted, “LEAD offers long term care providers interested in meaningful participation in value-based care a viable path forward, particularly for those hesitant about the cost and operational requirements of launching an Institutional Special Needs Plan.” She encouraged providers to evaluate the opportunity as CMS continues to consider additional refinements to LEAD.
Brian Fuller, managing director in ATI Advisory’s provider strategy and care transformation practice, observed that long term care providers are particularly excited about the LEAD model. “Across the long term care industry, there’s a lot of optimism about LEAD and its initial information,” he said. “They frequently mention high needs, and the high-needs track within REACH has been a very viable participation pathway; the results have been favorable both for CMS and for participants. There’s also mention of complex-care populations, dually eligible individuals. All of those line up nicely with the populations that the long term care sector serves, and that’s driving the initial optimism and level of interest that we’re experiencing.”
Geo AHEAD
Providers should also be aware of the introduction of the Geo AHEAD model, an update to the voluntary Achieving Healthcare Efficiency through Accountable Design (AHEAD) model. Expected to launch in 2028, Geo AHEAD will offer a new accountable care organization (ACO) track within the existing model, expanding total cost of care accountability to otherwise unattributed Medicare FFS beneficiaries in AHEAD’s participating states, currently Connecticut, Hawaii, Maryland, parts of New York, Rhode Island, and Vermont. While many details about the model are forthcoming, CMS has made clear its intention for Geo AHEAD to promote choice and competition—it requires participating states to implement a minimum of two policies in their health care markets—and to standardize hospital global budget methodologies for Medicare FFS in states that currently have rate-setting authority.
Other New VBP Models
MAHA ELEVATE
Another framework, the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-Based Approaches Through Evidence (MAHA ELEVATE) model, is not a reimbursement model but a voluntary CMS Innovation Center initiative funded through multiyear cooperative agreement to evaluate evidence-based lifestyle and functional medicine interventions currently not covered under Medicare FFS. It fits into the administration’s bigger push to support whole-person care with a focus on evidence-based psychological, nutritional, physical, and self-care interventions.
ASM
Other models less relevant to long term care providers include the Ambulatory Specialty Model (ASM), which makes outpatient specialists accountable for the quality and cost of services relating to heart failure or lower back pain. While ASM doesn’t directly affect SNFs and post-acute care providers, it may have indirect implications for coordinated care in the future.
GUIDE, WISeR, ACCESS
Guiding an Improved Dementia Experience (GUIDE) is a voluntary model intended to improve care for people living with dementia and their caregivers, which allows SNFs and post-acute care providers to participate as partner organizations. Wasteful and Inappropriate Service Reduction (WISeR) is also a voluntary model and aims to reduce low-value and clinically unsupported Medicare FFS services in six states, most notably by introducing prior authorization into Medicare FFS. Advancing Chronic Care with Effective, Scalable Solutions (ACCESS), another voluntary model, incentivizes technology-enabled care management for patients with chronic conditions but currently appears to exclude long term care settings.
How Providers Can Prepare for the New VBP Models
Hammel noted, “Many providers don’t realize their residents are already in ACOs, where they are helping manage care and improve outcomes without capturing the value they are creating.”
Fuller, at ATI Advisory, recommended providers take some simple but crucial steps to evaluate and prepare for the new models. First and foremost, he advised they turn to their data to get a sense of their needs, challenges, and opportunities.
“A lot of it starts with data,” he said. “How many providers do you have in your network? How many lives are they caring for? What would eligibility or attribution pathways look like for that population? Where are the opportunities to better improve costs, utilization, and outcomes for that population under the details of the program?”
He also suggested that providers undertake a capabilities assessment to determine if they have the means to participate in the new models. “Inside of organizations, you’ve got to have enhanced care management and care coordination, data and analytics, technology-enabled tools and solutions, actuarial and analytical support,” he said. “You also need to know if you can, on your own, go through the application process or if you need support.”
Peggy Stockel, CEO of independent/assisted living provider Stonehill Communities in Iowa, echoed Fuller’s advice. When she learned about the new CMMI models from a news article, her first move—after scheduling a call with Hammel at AHCA—was to look at Stonehill’s organizational preparedness.
“It’s about assessing readiness, looking at the talent and what it’s going to take to make it happen, and evaluating risk,” she said. “It’s also about getting the governing board on board and educating them about all the different things happening, because you can’t do it without the support of the governing board and executive leadership.”
Part of that strategic planning process is the evaluation of potential partnerships with outside organizations.
“Primary care drives so much of these models, and it’s not a business that we’re in,” Stockel said. “We have to look at where we can partner with others in the community so that we can have the best chance of success. We have to understand their world; they have to understand ours. And we can find those opportunities where we can work at it together and partner to take care of people.”
Depending on their experience with value-based payment models, providers may need to invest in new or enhanced operational capacities. “One is more robust care coordination, both inside of the facility and outside, post-SNF discharge,” Fuller said. “Coordinating downstream, making sure that patients are getting their home health visit, their durable medical equipment, their primary care physician follow-ups, that they’re not having any exacerbations, that they’re not at risk for hospital readmissions—all those things are important post-discharge.”
For some providers, the shift to value-based payment models also requires a renewed investment in data and technology. “SNFs are very good at tracking the things that drive their fee-for-service payment but not as good at tracking things that drive value-based care model payments, particularly longitudinally,” Fuller cautioned. “They may know very well what happens inside of their four walls, but they don’t have as much insight into what happens before the patient gets to them or after the patient leaves them. As you look at these models, whether they’re episode-of-care for thirty days or accountable care organizations for a full benefit year, knowing what’s driving cost and utilization in the pre- and the post-[care] period is important.”
At Stonehill Communities, Stockel and her team are already planning out their tech needs for the years to come. “We created a technology road map so that we can explore and evaluate what platforms are out there and what solutions can help us provide care,” she explained. “We’re looking at real-time data so that we can be data-driven decision-makers, and at how AI and predictive analytics can support us.”
A robust tech strategy will prove vital during the continued workforce shortages, with added pressure on organizations to think creatively and act nimbly, even as they’re navigating new reimbursement paradigms. From a labor perspective, that means educating employees about the new models and what it will take to adapt to them.
“A lot of it is educating them beyond just tasks and compliance, more toward outcomes and accountability,” Stockel said. “Working with physicians and all the stakeholders, it’s educating them on how we have to change the way health care is delivered, which changes how we’re reimbursed.”
Fuller also stressed the importance of business enablement—ensuring that organizations have the systems in place to thrive in the new payment terrain. “Technology is certainly a strong enabler of better management, but so are contracting structures and approaches,” he said. “Just knowing how to contract differently, either with the Innovation Center directly if you’re a participant or with hospitals or other partners if you’re partnering with another entity.”
Similarly, providers may seek partnerships with consulting or analytics firms that already have expertise with value-based payment models. “It’s hard to do all this work without the significant knowledge and experience as part of your team,” Fuller said. “Skilled nursing facilities have a day job, and it’s very easy for these more-strategic things to get pushed to the side of the desk while the day-to-day fires take all the air out of the room.”
Hammel emphasized the importance of providers being informed as the number of value-based models continues to grow. “Providers may ultimately decide not to participate, but it should be a conscious decision, not a surprise,” she said. “While the growing number of models can feel daunting, it also presents an opportunity by offering more pathways to participate.”
In addition to the toolkits AHCA/NCAL has developed for providers making sense of the new CMMI models, the Population Health Management Summit also offers an opportunity to learn about value-based care paradigms and connect with experts and potential partner organizations. The summit will take place in Baltimore, Md., on April 15–16, 2026.
Steve Manning is a journalist based in New York City.