Value-Based Contracting

CMS’s latest ACO REACH results strengthen the case for keeping or replacing advanced two-sided-risk population models: the soon-to-sunset model generated $988 million in Medicare savings in 2024, while participants such as agilon reported material gross savings and Medicare Trust Fund savings, sharpening the tension between model termination and the Trump administration’s broader push to expand accountable care (ACO REACH savings). At the same time, CMS is positioning MSSP and new pathways such as LEAD as the main vehicles for Medicare VBC scale, with organizations now weighing LEAD versus MSSP participation amid unresolved financial methodology details, while proposed physician payment reforms would phase out MIPS and further steer clinicians toward ACO participation (LEAD risk mitigation). For health systems, ACOs, and payers, the strategic priority is shifting from “whether to enter risk” to portfolio design—choosing between MSSP, LEAD, successor ACO REACH-like models, bundled payment extensions such as CJR-X, and MA risk-adjustment exposure as CMS tightens expectations around savings, coding accuracy, governance, and downside-risk readiness.