The landscape of value-based care is reaching a pivotal turning point. For years, healthcare leaders have navigated a patchwork of voluntary risk models, pilot programs, and incremental fee-for-service reforms. The Centers for Medicare & Medicaid Services (CMS) is making its strategic direction unmistakably clear: the future of reimbursement lies in mandatory nationwide risk models and continuous, tech-enabled chronic care management.

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Two landmark initiatives illustrate this shift: the CJR-X (Comprehensive Care for Joint Replacement Expanded) model and the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model. Together, these programs signal a fundamental move away from reactive, visit-based medicine toward proactive, outcome-driven care.

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Here’s what healthcare leaders need to know about these new CMS programs - and how organizations can adapt to protect their operational and financial health.

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1. CJR-X: Nationwide Mandatory Risk for Acute Procedures

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Launching January 1, 2028, CJR-X marks a massive expansion of episode-based payment models. Unlike previous voluntary iterations, CJR-X makes bundled payments for lower extremity joint replacements (LEJR) - including inpatient and outpatient hip, knee, and ankle procedures - mandatory for almost every acute care hospital nationwide.

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The Strategic Shift: A “Home-First” Post-Acute Strategy

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Under CJR-X, participating hospitals assume two-sided financial accountability starting the day of the procedure. Holding hospitals accountable for the total cost and quality of care through a 90-day post-discharge window forces a dramatic rethink of traditional post-acute discharge workflows.

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Executive Takeaway: To avoid financial deficits under CJR-X, acute care providers must shift from institutional post-acute care to a proactive, home-first recovery strategy. Keeping patients safely recovering at home while catching surgical or rehab complications early is no longer just a quality goal - it’s a financial imperative.

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To succeed under CJR-X, health systems must deploy tools that track post-discharge rehabilitation compliance in real time, and flag recovery risks long before they turn into costly hospital readmissions.

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2. The ACCESS Model: Transforming Chronic Care from Volume to Value

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While CJR-X targets acute surgical episodes, the 10-year ACCESS model tackles the ongoing burden of chronic disease management. Replacing traditional visit-based billing with Outcome-Aligned Payments (OAPs), ACCESS fundamentally changes how health systems and digital health organizations manage chronic conditions.

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Key Program Pillars

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• Primary Tracks: Focused on high-prevalence conditions including Hypertension (eCKM), Diabetes (CKM), Chronic Musculoskeletal Pain (MSK), and Behavioral Health (BH).
• Outcome-Aligned Payments: Providers are paid based on measurable health improvements - such as glycemic control or blood pressure stabilization - rather than simply the volume of patients enrolled.
• Funding Digital Health: ACCESS explicitly funds technology-enabled tools, including remote patient monitoring (RPM), wearables, asynchronous messaging, and AI-supported care coordination.

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The Strategic Shift: Continuous Patient Engagement

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Rather than waiting for a patient to schedule a routine follow-up appointment, ACCESS rewards organizations that leverage digital health tools to maintain continuous, real-time touchpoints. This continuous engagement enables clinical teams to adjust medications, address rising health risks, and keep patients on track between traditional office visits.

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3. The Common Thread: Predictive Insights & Operational Infrastructure

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Although CJR-X and ACCESS target different clinical areas, they share a core underlying thread: organizations cannot manage outcome-aligned or bundled financial risk without real-time decision support.

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Bridging clinical operations with financial risk requires infrastructure that can:

1. Identify risk early: Predict post-surgical complications or chronic care decompensation before emergency care is needed.
2. Track compliance offsite: Monitor whether patients are following home rehabilitation plans or managing chronic biometric markers.
3. Streamline coordination: Provide care teams with intuitive, AI-supported workflows that eliminate manual overhead and prevent burnout.

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At Radial, we empower health systems and provider organizations to navigate this transition smoothly. By delivering insights and decision support infrastructure, Radial helps clinical teams bridge the gap between day-to-day patient care and complex risk-bearing contracts.

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Looking Ahead: How Leadership Can Prepare Today

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Whether your organization is preparing for the mandatory rollout of CJR-X or optimizing existing workflows to capture revenue opportunities under ACCESS, early preparation is key:

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• Audit your post-acute workflows: Evaluate your current LEJR post-discharge pathways to ensure your home-first recovery capabilities are equipped for 90-day episode management.
• Assess your tech stack: Review how your continuous care technologies (RPM, patient engagement, AI coordination) integrate directly into clinician EHR workflows.
• Align clinical operations with financial strategy: Ensure your clinical teams have visibility into the specific metrics - such as readmissions and clinical outcome targets - that drive financial performance under new CMS reimbursement frameworks.

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The migration from volume to value is no longer a distant theoretical shift, it is operational reality. Organizations that invest in predictive, tech-enabled care infrastructure today will be best positioned to drive superior patient outcomes and ensure long-term financial sustainability tomorrow.

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