By Colleen Morley DNP, RN, CCM, CMAC, CMGT-BC, CMCN, ACM-RN, FCM, FAACM
Last month at the RISE Population Health Conference, I had the opportunity to sit among leaders, thinkers, and innovators committed to transforming health outcomes. One of the most impactful moments for me was the keynote delivered by Amanda Ryan, Deputy Director, State & Population Health Group, CMS Innovation Center. The clarity of vision, the focus on measurable health outcomes, and the emphasis on inclusive, sustainable models reinvigorated my interest in CMMI’s portfolio — especially its latest wave of announced innovation models. These new initiatives reflect a strategic push toward leveraging technology, enhancing accountability, improving access, and aligning long-term outcomes with payment reform that resonates deeply with the practice and purpose of professional case management.
I was interested primarily in 4 of CMMI’s newly announced models — ACCESS, BALANCE, LEAD, and TEAM — and wanted to share their emerging implications for coordinated care across populations.
ACCESS: Advancing Chronic Care with Technology-Enabled Solutions
The ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) represents one of the most significant shifts in how Medicare may support chronic disease care going forward. Traditionally, Original Medicare’s payment structure has provided limited pathways for reimbursement of technology-enabled care outside of conventional office-based services. Under ACCESS, CMMI proposes a voluntary, 10-year national test that ties payment to chronic-condition outcomes rather than discrete clinical activities.
What makes ACCESS particularly relevant for case managers is its emphasis on patient engagement and supportive technologies. By enabling a broader range of organizations — including digital health platforms, community-based providers, and technology-enabled teams — to participate in outcomes-based payment arrangements, ACCESS aligns directly with case management’s central aim: coordinating care around the whole person. This model invites creative, community-connected solutions to help patients manage chronic conditions more effectively, meet individualized goals, and reduce avoidable utilization.
For case managers, ACCESS opens doors to partnerships with technology innovators and community organizations that can enhance care delivery while being reimbursed for meaningful results, not volume. More to come on this!!
BALANCE: Lowering Barriers to Comprehensive Health and Nutrition
Obesity and metabolic disease continue to drive morbidity, acute exacerbations, and high cost across care settings. The BALANCE Model — Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth — seeks to address a growing unmet need by expanding access to select GLP-1 medications coupled with healthy lifestyle interventions for people with Medicare and Medicaid.
Historically, GLP-1 medications — which can support weight management and metabolic control — have been difficult to access due to cost and coverage restrictions. BALANCE aims to negotiate pricing directly with drug manufacturers on behalf of Medicaid agencies and Medicare Part D plans, and incorporate structured lifestyle supports to reinforce sustainable health behavior changes.
For case managers, BALANCE underscores the importance of integrating durable lifestyle and nutrition interventions with clinical care pathways. This model could herald a system where comprehensive health maintenance strategies are financially supported, enabling case managers to advocate more effectively for multidisciplinary support that extends beyond traditional medical interventions. Prevention, proactive and collaborative!
LEAD: Long-Term Enhanced ACO Design for Sustainable Accountable Care
The LEAD (Long-term Enhanced ACO Design) Model is CMMI’s newest accountable care framework, designed as a 10-year performance period with stable benchmarks and no rebasing. By building on experience from models like ACO REACH and expanding opportunities for providers who have historically faced barriers entering accountable care arrangements, LEAD aims to create a more inclusive, predictable, and sustainable approach to population health accountability.
This model reinforces a key evolution in the value-based movement: longer performance horizons with predictable financial frameworks that allow providers to invest confidently in care redesign and comprehensive population health strategies. For case managers, LEAD’s emphasis on coordinated care pathways and shared accountability aligns with core practices like risk stratification, longitudinal care planning, and outcomes measurement. Within LEAD, coordinated support services — from social determinants of health (SDOH) interventions to post-acute transitions — contribute to better outcomes; as we (case managers) have known forever!
TEAM: Transforming Episode Accountability in Surgical Care
The TEAM (Transforming Episode Accountability Model) Model focuses on improving the quality and cost of care for high-volume surgical episodes by encouraging better coordination across the continuum — from pre-surgical planning through recovery and transition to primary care. Fragmented surgical pathways often lead to avoidable complications, readmissions, and disjointed transitions. TEAM seeks to align accountability for outcomes, quality, and cost across all providers involved in an episode of care.
This model is particularly pertinent for acute care and post-acute case managers who are intimately involved in discharge planning, transition coaching, and continuity of care. TEAM provides a structured way to connect surgical care teams with case management workflows, ensuring that patient education, follow-up care, and continuity planning are not afterthoughts but essential, reimbursable components of episode success. A definite step forward for professional case management!
Innovation with Purpose and Patient-Centered Potential
The recently announced CMMI models — ACCESS, BALANCE, LEAD, and TEAM — reflect a strategic reorientation toward outcomes, inclusion, and sustainable transformation. As case management professionals, we stand at the intersection of patient experience, care coordination, quality improvement, and value-based outcomes. Each of these models offers new frameworks for collaboration, accountability, and meaningful engagement across care settings.
During the RISE Population Health Conference, hearing the CMMI Director articulate a future where innovation works in harmony with frontline care was not just inspiring — it was validating. These models reaffirm that meaningful transformation in healthcare doesn’t happen in isolation; it happens through aligned incentives, shared goals, and a relentless focus on improving health at the individual and population level.
As these projects move from announcement to implementation, case management leaders will have crucial roles in shaping how these frameworks translate into real-world care improvements — for patients, systems, and communities alike. Explore the site, get familiar. Even if you’re not “mandated”, there are some fabulous ideas and takeaways to create solutions for better outcomes and that adds to the evidence base for professional case management. Make 2026 the year Case Management roars!
The #CMSA2026 schedule is officially LIVE, and the education sessions are a total jackpot. Whether you’re a novice or an industry leader, we’re betting on your success with tracks like:
-Ambulatory Case Management
-Military & VA Excellence
-Legal, Regulatory & Ethical Issues
-Workforce Resiliency & Self-Care
Pro Tip: Pack your sunblock for the pool and your thinking cap for the sessions. It’s going to be a bright one in Las Vegas! 
See you at Mandalay Bay, June 16-19!
Register now with EARLY BIRD PRICING at: cmsa.societyconference.com
Bio: Dr. Colleen Morley, DNP, RN, CCM, CMAC, CMCN, CMGT BC, ACM-RN, IQCI, FCM, FAACM is the Associate Chief Clinical Operations Officer, Care Continuum for University of Illinois Health System and the current Immediate Past President of the Case Management Society of America National Board of Directors and President Elect of CMSA Chicago. She has held positions in acute care as Director of Case Management at several acute care facilities and managed care entities in Illinois, overseeing Utilization Review, Case Management and Social Services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management. Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her 1st book, “A Practical Guide to Acute Care Case Management”, published by Blue Bayou Press was released in February, 2022. Her 2nd book, "Practical Guide to Hospital Readmission Reduction , published by Blue Bayou Press was released in February 2024. Her 3rd book, "Practical Guide to Acute Care Case Management Leadership" is in the works, targeting publication in 2025. Dr. Morley celebrates 25 years of nursing experience and 20 years in case management in 2024. Her clinical specialties include Med/Surg, Oncology and Pediatric Nursing. She received her ADN at South Suburban College in South Holland, IL; BSN at Jacksonville University in Jacksonville, FL, MSN from Norwich University in Northfield, VT and her DNP at Chamberlain College of Nursing.