CMS Changes and the Future of Value-Based Care

Jennifer Houlihan and Jennifer Gasperini of Advocate Health discuss the impact of new CMS and CMMI leadership, current challenges in value-based care, and the future of ACOs, ECQMs, and Medicare Advantage. A timely conversation for anyone navigating the evolving policy landscape.

Welcome to the Move to Value Podcast, powered by CHESS Health Solutions.

In this episode, we’re joined by Jennifer Houlihan, Vice President, and Jennifer Gasparini, Director of Policy, from Advocate Health’s Population Health Team. Together, we unpack the implications of the recent administration change, explore what new leadership at CMS could mean for value-based care, and hear their perspectives on the legislative priorities they hope to see take shape.

Thomas Royal

Jennifer Houlihan, Jennifer Gasparini, welcome to the move to Value podcast.

Jennifer Gasperini

Thanks for having us.

Jennifer Houlihan

Happy to be here.

Thomas Royal

So you both just attended the NAACOS conference?

Can you tell us what are some of the hot topics that folks were talking about?

Jennifer Gasperini

I can get us started.

I think it's always great to see colleagues at the NAACOs conference and was also great to see Kim Brandt, who is the deputy administrator and COO at CMS, come and share some of Doctor Oz's priorities. For CMS and I think a lot of those priorities align really well with value based care. So they they really spoke a lot about tackling fraud and abuse. And as you know, ACOs are really the early identifiers of fraud.

And so really was pleased to see them talking about that and also using technology and better data really for beneficiaries and providers to advance care. And I think ACOs obviously are very focused on that goal as well.

Jennifer, do you have anything else to add there?

Jennifer Houlihan

Yeah. There, in addition, there were some really good sessions on the new team model, the transferring Episode Accountability model as well as guide and a lot of thoughtful conversation around how to integrate these models into the ACO and a clearer path for outcomes there. So I think there was a great discussion and got to give kudos to Jennifer. She was part of a really well attended and fantastic panel on how ACOs are adapting ECQMs and MIPCQMs and some of the kind of demands and multiple issues that are impacting ACOs on how to do all payer adjustments leveraging some of these requirements. So a lot of really timely topics and I think then the kind of final was Specialty Care integration, I think continued to be a recurring topic that we need to think more deeply about that and and how those get nested within cost, so hopefully we'll see more about that in the future.

Thomas Royal

So there is new leadership in place at HHS, CMS and CMMI.

What does NAACOS think this might signal for the future of value-based care?

Jennifer Houlihan

Sure, I I can. I can jump in on that one first, so I think you know, looking at Abe Sutton, you know, as as Jennifer mentioned, Kim Brandt was there from CMS. But we've also seen with Abe Sutton's appointment, who's been a strong supporter of value-based care. I think the mood was mostly positive, that there has been sort of a lot of statements, whether it's in some of the confirmation hearings, or direct statements that value-based care and the need to achieve savings is is one of the priorities. I think there's gonna be some different thinking about more aggressive requirements for more savings and as as as we've seen already, some of the model review that's already taking place. The ability to kind of end models early if they're not achieving the outcomes and the savings. So I think the mood in general is Value is still a strong part of CMS and CMMI’s agenda just the way some of the models will shape up and some of the strategic priorities, I think we're still waiting to see what that looks like. And Jennifer, I don't know if you have more to add on that.

Jennifer Gasperini

Yeah, Ditto on all those points. And of course the new leadership is very focused on MAHA or making America healthy again. and I think value really fits in that lens.

And so hopefully we'll see more focus on prevention and Wellness and maybe even some new models that are introducing new concepts around prevention and Wellness as well, hopefully, but we do expect to see more from the new leadership team at CMMI on their strategy in the coming months and that will be really telling, I think, in terms of what their spin on value and their focus will really be.

Jennifer Houlihan

And I'll just talk.

I mean, we did one of the first signals we saw was in the new the the 2026 proposed inpatient rule and team. The team model is is remaining as a mandatory model.

And so I think there were, there are some early signals, but as Jennifer said, we're really waiting for that strategic refresh and then more really frankly announcements on any what the, the future model changes will be.

Thomas Royal

Interesting. So. So my next question is a bit duplicative, but I'd like to know what stands out to you about the new head of CMMI and how do you see his vision shaping programs like ACO REACH?

Jennifer Gasperini

Yeah.

Yeah, I think like you said, you know, I'll be a little repetitive here, but I think well, Abe Sutton, you know does have experience in value models. So that is very helpful and has experience working in the first Trump administration. But I I think his knowledge of value based care will help shape the new strategy at CMMI and the agenda at CMMI and tying that work obviously back to Maha goals is something that we really expect.

Jennifer Houlihan

I mean, you asked specifically about ACO reach and I think we've been hearing lots of rumors. We've heard everything from the could ACO REACH be extended.

Will it be replaced by something like the a revised Geo contracting model?

I think there's a lot of what if scenarios right now. So it's hard to say. But as Jennifer said, Abe Sutton does have a lot of experience. He was the architect of some of the kidney care models. And so I think that's where we're wanting to also see what's next for full risk models, but again also with an eye towards how are we thinking about specialty integration and some of these full risk models. And so I think there might be some good alignment opportunity there as well.

Thomas Royal

So historically, how has leadership turnover at HHS impacted innovation models and payment reform initiatives?

Jennifer Gasperini

Yeah, I think so, the impact has been pretty minimal in the past. There's always a period of reorganization, of course, when new leadership comes on, they identify new priorities. They typically issue a lot of RFI’s or requests for information to gather feedback from stakeholders, and we're really already experiencing those things now.

I do think we'll have a lot of opportunities to share input on future direction and maybe what we feel hasn't been working, especially in the vein of regulatory relief. That's an area they've been really focused on initially, but you know, obviously we are losing some staff that is has a lot of institutional knowledge. And so, I think.

Time will tell in terms of, you know what the the true impact is on the programs.

Thomas Royal

Yeah, 'cause, there's definitely been a wave of layoffs across the healthcare policy space. And so how are these reductions in force impacting value based care programs, especially ACO reach?

That's one thing that's that's come up as as we've been out having conversations with folks, boots on the ground and how that's going to be impacted.

You have any thoughts about that?

Jennifer Houlihan

I mean some of the impacts in addition to staffing are coming through changes or directives from the executive orders. So I think that is having an impact and maybe that is to the extent that we're seeing it now, maybe that's a difference between previous administration turnovers and transitions versus now is the amount of executive orders and some of the directives. I mean I think for ACO REACH, I'm not as directly involved with it, and I know Jennifer is more so maybe can speak more directly, but I think some of the staff is definitely still there and they're trying their best to follow like new leadership direction executive you know.

Executive order implementation and so I think there was some pause and communications early on, but I don't know, Jennifer, from your standpoint if that seems to have kind of resolved and it’s business as usual, of course.

Again, waiting for any, you know that model I suspect is under review. Like all the other models have been under review and we could expect to see more changes.

Jennifer Gasperini

Absolutely. And you know, like MSSP, they have lost some staff with a lot of institutional knowledge. And so I think there will be a transition period.

Will they hire up then and hopefully get some some new smart folks into those roles.

They've also done, you know, some pulling back of the ACO coordinator positions in an effort to centralized so most of those positions were in the regional offices, previously and we're seeing CMS move to a more central approach and and therefore we've lost a number of ACO coordinators and so for MSSP and and ACO reach but as Jennifer mentioned, I think we're starting to see