Population Health Management

CMS is broadening the ACCESS Model to additional chronic conditions, signaling that the Trump administration’s CMS under Dr. Mehmet Oz and CMMI Director Abe Sutton is positioning specialty population-health models around cross-payer alignment, chronic disease management, and Medicaid participation rather than isolated Medicare pilots (CMS ACCESS expansion). In parallel, payers and providers are tightening condition-specific VBC plays—DaVita’s expanded Humana CKD partnership, SCAN’s Walmart Medicare Advantage strategy, and rural systems preparing for value-based care—while measurement infrastructure is also shifting as NCQA uses Komodo data and AI to develop future HEDIS measures. The strategic tension for ACOs and risk-bearing organizations is that chronic-condition VBC is gaining policy and commercial momentum, but evidence remains uneven, particularly in virtual CKD solutions, forcing leaders to distinguish scalable population-health infrastructure from vendor-led disease management that may not improve outcomes or total cost of care.