Panel Emphasizes Need for Accessible Preventive Care During V-BID Summit

A panel of experts at the 2026 virtual V-BID Summit focused on the importance of accessible preventive care during the session “Access to Evidence-Based Preventive Care Services.” The discussion surrounded the implications of the decisions made in the Braidwood v Kennedy case, the Make America Healthy Again (MAHA) model, and gaps in coverage and implementation.

CMS Innovation Center Strategies for Preventive Care

Preventive care accessibility often starts at the federal level, as funding and strategies trickle from the top to local care centers. Susannah Bernheim, MD, MHS, the chief quality officer and acting chief medical officer at the CMS Innovation Center, outlined the strategies that the government has implemented to make preventive care more accessible and the evidence-based prevention pillar of the Innovation Center’s health care strategy.

Primary care, said Bernheim, has historically been the focus of the Innovation Center, and preventive activities can be found in regular primary care. However, the new strategy at CMS is to emphasize lifestyle, nutrition, and physical activity in payment models.

“It’s not that we don’t know that nutrition and physical activity make a big difference for primary prevention, secondary prevention, and tertiary prevention, but we don’t necessarily do a great job,” she said. The new models will be used to help develop evidence about how to implement changes in care delivery and payment to encourage nutrition and physical activity.

Bernheim focused on levers that CMS has the capability to pull to properly focus on these topics. Measurement is a feature of the value-based payment models, including measuring key aspects of prevention. This includes figuring out how to measure whether the risk of developing a disease is being reduced, measuring functional status, and measuring well-being as part of the prevention activities. Beneficiary engagement is another tool that the Innovation Center is aiming to use, including offering incentives to beneficiaries, such as in the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (ACO REACH) model, where patients can be rewarded for engaging in chronic disease management.

Supporting providers is also something that the Innovation Center is interested in, said Bernheim. An example she gave was from ACO REACH, where there was an increase in the number of ACOs that had formal partnerships with community-based providers, which can provide services like supporting fall prevention or connecting with the Medicare Diabetes Prevention Program lifestyle changes. Asynchronous access to that program can boost uptake of the scientifically backed model to help people with prediabetes.

Bernheim also covered MAHA Elevate, which is a different model that will provide approximately $100 million to fund up to 30 cooperative agreements with a 3-year term. This funding will likely go to practices with experience in delivering an intervention that Medicare doesn’t currently cover. The Long-term Enhanced ACO Design (LEAD) model is a 10-year model and is meant to bring in different kinds of providers and has more stable benchmarks.¹ CMS wants to hold providers accountable for doing preventive tests and seeing what works.

“I don’t think we’re going to answer the question of should people run 30 minutes or walk 40 minutes… We’re trying to say, How do payment and care models help providers help their beneficiaries, because that’s really our job,” Bernheim concluded.

Braidwood v Kennedy Has Significant Impact on Preventive Care in the US

The decision from the Supreme Court to side with HHS in the Braidwood v Kennedy case had heavy implications for the accessibility of preventive services in the US. Namely, the court’s decision reinstated the mandate that all insurance must cover preventive services recommended by the US Preventive Services Task Force after 2010 under the Affordable Care Act (ACA).² Richard H. Hughes IV, JD, a member of the Epstein Becker Green law firm, discussed how important this decision was.

“This was the most significant challenge to date that we’ve seen to the ACA’s preventive services coverage requirement,” he said. “We saw those contraceptive mandate challenges a few years before but Braidwood really squarely took on the entirety of the preventive services coverage requirement because the plaintiffs had religious objections…”

Hughes noted that the primary argument had to do with the Appointments Clause, which states that all officers of the US who make decisions for the public need to be confirmed by the Senate after being appointed by the president. Ultimately, 6 justices of the Supreme Court agreed that the chain of command of the HHS secretary and the president was enough to rule in favor of the HHS.

Hughes noted that there are differences between the USPSTF and other committees, such as the Advisory Committee on Immunization Practices, whose recommendations are reviewed by the director of the CDC, because there is language that politically insulates the USPSTF in law. To keep the preventive services alive, the health care community had to accept the government’s case that the secretary of the HHS has the ability to decide to adopt or reject the recommendations made to keep political accountability.

“That was an uncomfortable position to take, for obvious reasons, and as last year progressed we had the decision in June, but that’s happening against the backdrop of the secretary undermining these recommending bodies,” said Hughes. “But ultimately we came out in what I’ve called a double-edged sword.”

A lawsuit that Hughes is bringing to court questions the processes that HHS Secretary Robert F. Kennedy Jr has undertaken to change the immunization schedules and COVID-19 policy under the Administrative Procedures Act, as certain steps have to be followed before they can be made permanent. Hughes concluded that he hopes that this lawsuit prevails.

Maintaining High Screening Rates Can Benefit Cancer Prognosis

With the Braidwood v Kennedy case maintaining access to preventive services like cancer screening, it is important that these preventive services are used by the patients at risk. Robert Smith, PhD, senior vice president of early cancer detection science at the American Cancer Society, discussed the importance of getting patients to adhere to cancer screening and the challenges that come with achieving high screening rates.

“A lot of factors go into whether you avoid a premature death or not, but cancer accounts for the majority of premature deaths in this country. It’s the leading cause of premature death,” said Smith. “The 5 cancers [that can be screened for] account for about half of years of preventive life loss.”

Smith noted that there has been much progress in preventing cancer deaths over the past 30 years, including approximately 4.8 million lives saved due to reducing deaths each year through treatment progress and early detection. However, improvement is still needed. Not only should preventive measures be suggested, but the implementation should be smoother when more people will be coming to get screened. Guidelines, he said, are also out of sync, which can make a clinician’s life more difficult overall and makes it harder for patients to understand when they need their screening and how much it costs.

The definition of screening vs diagnostic under the ACA can also complicate coverage and reimbursement for patients looking to get screened. Screening tests, he said, are not diagnostic tests. This idea needs to be pushed, as it can affect when a test is covered at no cost.

“Screening is better [when] really thought of as a continuum of information gathering in which we are attempting to answer a fundamental question that led the patient to get screening in the first place: do I or do I not have cancer?” explained Smith. “If you think of it as this discrete thing…with right and wrong answers, you sort of create a false sense of what’s really required to have a successful screening event.”

Making sure to follow up on screening events when they return a positive result is also a paramount concern, as screening is not effective if a patient cannot follow up on their results and can lead to more death. Smith also called for ensuring guidelines are updated consistently to match the new evidence, whether that’s every year or every 5 years.

Overall, the panel emphasized the need for continued work in the space of preventive medicine through collaboration between clinicians, the government, and even lawyers who can defend the right to preventive services at affordable and accessible points. Future work in the space needs to ensure that preventive care is clear for patients to understand so as to improve outcomes for preventable conditions.

References

1. LEAD (Long-term Enhanced ACO Design) model. CMS. Updated February 18, 2026. Accessed March 12, 2026. https://www.cms.gov/priorities/innovation/innovation-models/lead
2. Bonavitacola J. Supreme Court decision on Braidwood protects insurance coverage of preventive care. AJMC^®. Updated June 27, 2025. Accessed March 12, 2026. https://www.ajmc.com/view/supreme-court-decision-on-braidwood-protects-insurance-coverage-of-preventive-care