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The CMS Innovation Center wrapped up 2025 by announcing seven new models (in addition to WISeR, ASM, and the revised MDPP Model announced earlier in the year) that support evidence-based prevention, patient empowerment, and greater choice and competition. Here’s a recap of each model, its goals and how it will help people live healthier lives.
In this Edition:
- Model Updates
- Value-Based Care Spotlight Update
Model Updates
GENEROUS Model
Announced on November 6, the GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model is designed to reduce drug costs in the Medicaid program and reflects this Administration’s commitment to tackle high drug prices. By engaging directly with drug manufacturers, CMS will negotiate lower prices to what other comparable countries pay, reducing burden to Medicaid programs and allowing for states to do more to support some of our most vulnerable populations.
ACCESS Model
The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, announced on December 1, tests an outcome-aligned payment approach designed to give people with Original Medicare new options to improve their health and prevent and manage chronic disease with technology-supported care. The voluntary model focuses on common conditions, such as high blood pressure, diabetes, chronic musculoskeletal pain, depression, and other conditions affecting millions of Americans. Related podcasts: The ACO Show, Moving Medicine (AMA),Vital Signs
MAHA ELEVATE Model
The voluntary MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) Model will provide approximately $100 million to fund 3-year cooperative agreements for up to 30 chronic disease prevention and health promotion pilot projects. Projects will utilize evidence-based functional or lifestyle medicine interventions currently not covered by Original Medicare. The model was announced on December 11, and a Notice of Funding Opportunity will be released early this year for the first cohort.
LEAD Model
The LEAD (Long-term Enhanced ACO Design) Model, announced on December 17, is the Innovation Center’s next Accountable Care Organization (ACO) model. LEAD’s improved benchmarking methodology and other design features will support a broader mix of providers, including those new to ACOs; smaller, independent, and rural-based practices; as well as others who provide care to high-needs patients with more complex challenges. Related podcast: Moving Medicine (AMA)
GLOBE Model
The proposed mandatory GLOBE (Global Benchmark for Efficient Drug Pricing) Model, announced on December 19, would lower prices of drugs covered by Medicare Part B to what other comparable countries pay through manufacturer rebates, helping reduce out-of-pocket drug costs for people with Medicare and resulting in savings to Medicare.
GUARD Model
On December 19, CMS announced the GUARD (Guarding U.S. Medicare Against Rising Drug Costs) Model, 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. GUARD would help make critical medications more affordable for people with Medicare Part D, while also improving the sustainability of the Medicare program and the Medicare Trust Fund and protecting innovation.
BALANCE Model
The BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth)
Model was announced on December 23 and aims to increase access to select GLP-1 medications and healthy lifestyle interventions to help people with Medicare and Medicaid improve their long-term health, potentially preventing chronic disease and disability. As part of this voluntary model, 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.
Model Milestones
ASM & WISeR
The ASM (Ambulatory Specialty Model) was finalized in the Calendar Year (CY) 2026 Physician Fee Schedule (PFS) Final Rule.
The WISeR (Wasteful and Inappropriate Service Reduction) Model performance period started on January 1. Read new information about the model and its testing of participant electronic portals in the FAQs.
Related podcast: Healthcare Trailblazers
Value-Based Care Spotlight
Introducing the “3 Things I Wish I Knew” Series
Health care providers share their experiences transitioning to value-based care, offering words of wisdom on how they found success in the series: “3 Things I Wish I Knew.” Have good advice to offer providers who are considering the shift to value-based care? Let us know by sending an email to ContactCMMI@cms.hhs.gov with the subject line 3 Things I Wish I Knew!
Find more CMS Innovation Center news and information at https://www.cms.gov/priorities/innovation/overview. We’ve recently revamped our site to make it easier for you to find the information you’re looking for. Connect with us!
Follow us on social media to get real-time updates: X: @CMSinnovates; LinkedIn:Centers for Medicare & Medicaid Services
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