The Center for Medicare Innovation launches "New Strategy to Make America Healthy Again" (MAHA).
There was a webinar on May 13, 2025, led by CMS Administrator Dr Mehmet Oz, and Innovation Center director Abe Sutton.
Here's a summary from the announcement:
Building on 15 years of Innovation Center experience and lessons learned, the strategy focuses on three pillars:
- Promote evidence-based prevention. Prevention will be part of every model; interventions will be closely monitored to ensure they are on the path to certification for expansion, contributing to broader disease prevention, health promotion and reduced overall costs.
- Empower people to achieve their health goals. The Center will increase patient access to information and tools for disease management and healthy living and align financial incentives with health.
- Drive choice and competition. The Center will reduce administrative burden and increase independent provider participation in models, giving patients more options for care at a lower cost.
See also: A memo by the center's director, Sutton, here. See a CMS Newsroom Blog by Sutton here. A CMS website on innovation strategy priorities here. PPT deck 25pp here.
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Sutton was featured in an article at Stat Plus back on January 15, 2025. As I wrote at the time,
- Abe Sutton, who's crammed McKinsey, White House, Harvard Law School, and Rubicon Advisors into the last several years, was said to be a pivotal figure in a big, cross-agency renal program rolled out by the prior administration in 2019.
Here is a detailed strategy analysis of the four CMS Innovation Center (CMMI) documents released May 13, 2025—including the PowerPoint deck, formal strategy statement, white paper, and blog-style press release by Deputy Administrator Abe Sutton. This briefing is designed for health industry stakeholders—payers, providers, policy strategists, and innovators—who want to understand and leverage the CMS Innovation Center’s evolving direction.
🔷 Executive Summary: Strategic Imperatives for the Health Industry
CMMI's 2025 strategy, branded "Make America Healthy Again," pivots sharply toward prevention-first health care, demanding deeper provider accountability and intensifying financial risk transfer from CMS to providers and plans. The message is clear: the health industry must adapt to a taxpayer-protective, risk-bearing, and prevention-aligned future—or risk exclusion from upcoming models and value-based frameworks.
CMMI is explicitly repositioning itself as a market shaper, not just a pilot funder. Industry leaders must now align with this directional vision in real time, even before models are formally released or codified.
🔷 Structural Overview of the Strategy
The four documents share a consistent three-pillar framework:
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Promote Evidence-Based Prevention
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Empower Patients
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Drive Choice and Competition
All are anchored by a foundational commitment to taxpayer protection and systemic cost reduction.
🔶 Detailed Strategic Insights by Pillar
1. Evidence-Based Prevention
“Prevention will be embedded in every model we test.” – Abe Sutton
Key Initiatives:
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Primary, secondary, and tertiary prevention incorporated across all payment models
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Incentives for nutrition, exercise, and even alternative medicine
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Waivers to enable non-traditional services (e.g., caregiver payments, flexible DME rules)
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Evaluation metrics include “days at home” and intermediate markers of health gain
Implications for Industry:
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Payers and ACOs must integrate lifestyle medicine and prevention support into core benefits
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Vendors and digital health companies offering preventive tools (e.g., mobile nutrition tracking, virtual coaching) have a clear alignment path
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Providers must prepare for new performance metrics tied to early-stage intervention and prevention, not reactive care
2. Patient Empowerment
“Access to relevant and usable data is key.” – CMS White Paper
Key Initiatives:
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Data democratization: Patients get app-based tools and transparent provider cost/quality data
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Providers evaluated on patient-reported outcomes (PROMs), ADLs, lifestyle measures
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Testing of predictable cost-sharing models for high-value services
Implications for Industry:
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Plans and provider groups must build patient-facing tools with decision support and transparency
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Health IT companies should accelerate integration of PROMs and consumer-friendly data
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Industry must track how CMS handles cost-sharing waivers and V-BID insurance designs
3. Choice and Competition
“CMS will support more independent physician participation in VBP models.”
Key Initiatives:
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Support for independent providers through advance shared savings and prospective payments
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Expansion of site-neutral payments, at-home care, and scopes of practice
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Standardized model design features to reduce administrative burden
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Potential limits on state-level rate setting
Implications for Industry:
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Health systems must prepare for competition from nimble, risk-ready independents
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Private equity and MSOs supporting independent physician practices have significant growth opportunity
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MA plans and ACOs must optimize model administration and prepare for simplified benchmarking/attribution
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Expect a regulatory tilt away from state control (e.g., Certificate of Need limits)
🔷 Cross-Cutting Themes to Watch
🔹 Strong Language on Risk Transfer
CMS is mandating downside financial risk across all future models and will prohibit “risk-only” conveners.
Industry Takeaway: Entities must demonstrate real capital or actuarial credibility. Pass-throughs and loose affiliations will be scrutinized.
🔹 Emphasis on Evaluation and Certification
Models will not be sunset prematurely and will require certification paths to justify continued expansion.
Industry Takeaway: CMMI seeks to avoid churn by stabilizing models longer—but only if early metrics are favorable. Prepare to align with certifiable outcomes from day one.
🔹 Prevention as an Economic Strategy
“Ultra-processed foods, sugary drinks, and sedentary lifestyles” are explicitly named as root problems.
Industry Takeaway: Expect CMS to intervene indirectly in food, fitness, and lifestyle markets through coverage rules, flexibilities, and incentives. Nutrition and lifestyle companies are adjacent beneficiaries.
🔹 Federalism Shift and Preemption Signals
CMMI may seek to curtail state roles in rate setting and reduce barriers like state CON laws.
Industry Takeaway: CMS is moving toward greater federal authority in defining payment norms across states. This could disrupt state-run Medicaid innovation models and recalibrate commercial rate negotiations.
🧭 Strategic Recommendations for Health Industry Leaders
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Prepare for full-risk models. Health systems and ACOs must build the governance, capital, and analytics backbone to shoulder global risk—CMS will no longer fund passive experiments.
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Position early in prevention infrastructure. Engage in pilots or pre-model initiatives for lifestyle-based, app-driven, or virtual prevention tools.
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Elevate your data strategy. Patient-facing data tools, cost transparency, PROMs capture, and interoperable dashboards are no longer optional.
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Revisit MA strategy. Expect pressure on MA plan design, benchmark reform, and consumer tools.
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Back independent provider growth. Investors and MSOs should expand capital and operational support for physician practices who will now be favored in risk-bearing models.
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Track waivers. Stay alert for flexibilities CMS grants under model authorities—this includes new DME access rules, scope expansions, and caregiver payments.
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Engage CMMI. They explicitly invite “partnership”—early feedback can shape waiver designs, flexibilities, and model definitions.
🧩 Final Thought
These CMMI documents constitute more than a roadmap—they mark a governing philosophy. The future CMS envisions is proactive, consumer-informed, market-engaged, and taxpayer-protective. Health industry players must pivot from reacting to pilots to actively designing for a system that rewards prevention, transparency, and real fiscal discipline.
Let me know if you'd like a slide deck, executive summary, or action plan derived from this strategy brief.
