Value-based care is a health care delivery and payment framework that ties provider reimbursement to the quality and efficiency of care rather than the volume of services delivered. Under traditional fee-for-service (FFS) Medicare, providers are paid for each individual service they perform. Value-based care models restructure those incentives so that providers are rewarded for keeping patients healthy, reducing avoidable hospitalizations, managing chronic diseases effectively, and achieving measurable clinical outcomes.
Connected care programs sit at the intersection of fee-for-service and value-based care. CCM, RPM, and APCM are fee-for-service reimbursements for care management activities, yet the services themselves are fundamentally oriented toward value-based goals: longitudinal patient engagement, proactive chronic disease management, and coordinated care. The ACCESS Model, launching in July 2026, goes further by tying payment directly to measurable health outcomes rather than defined care activities.
CMS pursues value-based care through several mechanisms:
The Quality Payment Program (QPP):
ACOs are groups of providers that agree to be collectively accountable for the quality and cost of care for a defined population of Medicare beneficiaries. As of January 2026, the Medicare Shared Savings Program includes 511 ACOs serving 12.6 million Traditional Medicare beneficiaries.
Accountable Care Organizations (ACOs):
Each of the three RVU components is adjusted by a geographic multiplier that accounts for cost-of-living variation across the country. Practices in high-cost areas receive higher payments; practices in lower-cost areas receive lower payments.
Innovation Models (CF):
CMMI tests payment models including Making Care Primary, Primary Care First, ACO REACH, the forthcoming LEAD Model (launching January 2027), and the ACCESS Model.
Connected care services are tools that practices use to manage their attributed populations, reduce total cost of care, and meet quality benchmarks under these models.
Budget Neutrality:
CMS is required to maintain budget neutrality when making changes to RVUs. If changes to one set of codes increase spending, CMS must offset those increases by reducing payments elsewhere. This mechanism means that increases in reimbursement for some services can cause decreases for others, and it has been a persistent source of tension between specialty societies and primary care organizations.
Annual Rulemaking Process:
The PFS is updated through formal notice-and-comment rulemaking. CMS publishes a proposed rule in the Federal Register (typically in July), solicits public comments over a 60-day period, considers the comments, and publishes a final rule (typically in November) that takes effect January 1 of the following year. All connected care reimbursement changes flow through this process.
Sources:
Social Security Act ยง 1848 (MACRA);
CMS Quality Payment Program overview;
CMS 2026 ACO Initiatives Participation Highlights.
The Advanta team is ready to discuss the details of Connected Care.
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