V-BID Summit 2026 Highlights Value-Based Care and Equity With CMMI Director

The University of Michigan celebrated the 21st anniversary of its annual V-BID Summit on March 11, 2026, highlighting pathways to improve value-based insurance design and ensuring equitable health care for all.

The meeting kicked off with a fireside chat with Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI) and deputy administrator for CMS. The V-BID Summit’s overall aim is to address “clinical nuances” and propose solutions to match patient needs with quality care, appropriate coverage, and spending. Sutton began the fireside chat with solutions to unlocking affordability by increasing productivity in other areas of health care, like retaining health care providers such as nurses and doctors.

Health Care Productivity and Value-Based Payment Reform

“Much of our health care system is a labor-dependent equation,” Sutton said. “We take labor [and] we compete to retain it in the health care workforce, as opposed to other parts of the economy that have increased productivity and therefore can pay more for that work overtime.”

Productivity unlocks a range of implementations that would refine hospital operations, such as investing in the drug space and paying for outcomes that use technology. Using payment models such as these would help the federal agency to increase health care access at a more affordable price for taxpayers and the government, Sutton said.

More specifically, Sutton named various current models that have adopted incentives for increased productivity. Of the 9 CMMI models established in the last year, 4 are connected to drug pricing and 2 to technology, thus compounding productivity incentives onto previous models.

“Think about the classic Accountable Care Model [ACO] or value-based competition model,” Sutton said. “A lot of that has, in the past, been about optimization on factors that are largely inherent in the model itself and not things we want it done.”

For example, the LEAD (Long-term Enhanced ACO Design) model encompasses the productivity incentives Sutton mentioned and revisits the benchmark structure under the ACO that has historically high costs. Under LEAD, patients’ risk assessment is incorporated into their benchmark assessment, putting patients in “approximately the right position.”

CMS Drug Pricing Models and Most Favored Nation (MFN) Strategy

Expanding on the drug or pharmaceutical aspect of newer models, Sutton emphasized that the global economy is outpacing pharmacological innovation.

“If we can act today to make drugs more affordable for the American people, we will set up a sustainable equilibrium, as opposed to our status quo, which has proven itself unstable,” he said.

To execute this, Sutton proposed a pharmacological economic sphere that ties US payments into a “basket” that involves other developed countries. This, he said, would give the US global leverage, allowing the government to shape pharmaceutical incentives.

“The idea of most favored nation [MFN], or of taking an international pricing index and tying what we pay to some average of that, is one that can [lower drug prices],” Sutton said. “And I think that is the answer for how we make drugs more affordable today, while sustaining the incentive to encourage further development.”

The GENEROUS model already utilizes this strategy; although it is a voluntary model, it offers states an alternative rebate structure should the MFN pricing fall below the state’s price. The other 2 models that embody MFN pricing and utilization are the GLOBE and GUARD models.

The GLOBE model would be a mandatory Part B model operation in 25% of the country to impose CMS Part B drug sales in place of the average sales price plus 6% add-on approach. In comparison, the GUARD model implements MFN pricing into Part D in 25% of the country, although neither model is completely finalized.

“GENEROUS accrues the benefit of state Medicaid programs, putting additional resources into states’ budgets and the Medicaid program to support our most vulnerable,” Sutton explained. GLOBE directly translates into lower drug prices for patients who are beneficiaries of the Medicare program through Part B. Finally, GUARD translates into more stability for the Part D program.”

Sutton also highlighted 2 other models that focused on increasing access to specific drugs that target common conditions like overweight, obesity, diabetes, and sickle cell disease. The BALANCE model, targeting glucagon-like peptide-1 receptor agonists, was created in collaboration with Eli Lilly and Novo Nordisk to make these medications more accessible to a “broader array of Americans,” Sutton said.

The other model focuses on cell and gene therapy, specifically sickle cell disease, and on expanding access to an otherwise expensive treatment for Medicaid beneficiaries.

Using this model, which began under the Biden administration and has since been adopted by 33 states, Sutton said, “We've gotten to the point where 86% of Medicaid beneficiaries with sickle cell disease are covered by the scope of the cell and gene therapy model.”

Artificial Intelligence and Digital Therapeutics in CMMI Payment Models

Artificial intelligence (AI) use in health care is continuing to expand; however, despite its value, Sutton said there’s no “clean incentive” to adopt such a tool. Having a new technology payment for AI or putting AI on the fee schedule to increase adoption is problematic, he said, “because the AI does not have a natural limit on its use.”

Because AI can be used exponentially, unregulated use could make health care more expensive, especially when based on patient outcomes rather than overall patient health. Instead, Sutton suggested shifting toward paying for health outcomes rather than specific technical activities, rather than focusing on the technology itself. This approach enables a “productivity unlock” in which technology, such as AI, can be applied in a deflationary manner.

One primary example of this shift is the ACCESS model, which centers on digital therapeutics. This model utilizes 4 tracks: cardio-kidney-metabolic health (early and advanced), musculoskeletal (MSK), and behavioral health.

Rather than a traditional fee-for-service approach, the ACCESS model provides a monthly engagement payment followed by an additional payment if the provider successfully drives health improvements in at least half of their engaged population. Sutton noted that this creates a real market for health-tech companies to engage Medicare beneficiaries in managing chronic conditions while translating into large savings for the healthcare system.

“One of the positive things…is that we get to experiment with things that modify parts of the statute and see if they work, and if they do work, improve quality, lower cost, then we could run them as perpetual models,” he said.

Future of Medicare and Medicaid Innovation Through CMMI Models

Looking ahead, Sutton acknowledged that while significant progress has been made with the current portfolio of nine models, several gaps remain. Specifically, he pointed to the need for a more "thoughtful approach" to accountability in the Medicaid pediatric space and to further expanding incentives in the drug and kidney care sectors.

Ultimately, the goal of these initiatives is to ensure the long-term viability of the Medicare and Medicaid programs by fundamentally changing how care is delivered. Sutton concluded the session by inviting stakeholders to share ideas for large-scale systemic impact, noting that the Innovation Center is actively seeking new perspectives and expertise to help design the next decade of American health care.

“It's like taking up the things that we truly see making a difference in the system and trying to move the needle in a larger way,” Sutton said.