New CMS Models and What They Mean to Long Term Care Providers

The transition from fee-for-service to value-based care in long-term and post-acute care is accelerating, driven by CMS's recent introduction of 11 new payment models. These initiatives, including TEAMS, AHEAD, and LEAD, emphasize provider accountability, patient engagement, and cost containment through improved quality outcomes. Nisha Hammel, Vice President of Reimbursement Policy and Population Health for AHCA and NCAL, notes that over 70% of payments are now linked to quality metrics. To navigate this shift, providers must analyze baseline data like readmission and emergency department utilization rates while assessing their clinical capacity for proactive, on-site care. Many providers are already indirectly participating in Accountable Care Organizations, making it critical to identify these existing relationships. Success requires moving beyond traditional service-based models toward strategies that prioritize long-term stability and coordinated care for complex, high-need populations.