VBC Programs Impacting Hospitals & Health System Decision-Making in 2026

This list is an overview of the programs your sales and biz dev teams should be discussing with buying committees and compliance roles from the first point of contact. 

By aligning your solutions with these programs, you have a ready-made business case along with a path to funding signing on with you.

 

 

Mandatory Programs (Automatic Participation)

Every eligible acute care hospital is already subject to these — no opt-in required:

Program	What It Affects
Hospital VBP	Incentive/penalty adjustments to Medicare IPPS payments (~3,100 hospitals)
HRRP	Payment penalties for excess 30-day readmissions in 6 conditions
HAC Reduction	1% payment penalty for bottom-quartile hospitals on acquired conditions
TEAM	Mandatory episode bundles for 5 surgical procedures (lower extremity joint replacement, CABG, spinal fusion, HHCHB, major bowel procedures).  Active Jan 2026
ASM (Ambulatory Specialty Model)	Mandatory episode payments for cardiology, pulmonology, and nephrology; launches July 2026. Applies to hospital outpatient and employed specialists.
IOTA	Mandatory transplant performance payments for ESRD transplant centers; active July 2025
Promoting Interoperability	EHR/data exchange requirements tied to hospital payment

Voluntary Models 

These require opt-in but are directly built for or commonly adopted by health systems:

 

Program	Why It Matters to Health Systems
ACO REACH	Total cost of care accountability; active through 2026. Enterprise health systems frequently serve as ACO sponsors.
LEAD	Replaces ACO REACH in Jan 2027; 10-year model. A major long-term commitment for large integrated systems
AHEAD	State-level global budgets; health systems in MD, CT, HI, VT, RI, NY must align with state participants.
EOM	Oncology episode payments; relevant to health systems with cancer service lines
GUIDE	Dementia care coordination; relevant to health systems with neurology and geriatric programs
IBH	Integrated behavioral + physical health; highly relevant to IDNs with behavioral health lines
KCC	Kidney care choices; relevant to systems with nephrology/ESRD programs
TMaH	Maternity care transformation for Medicaid/CHIP; relevant to OB-heavy systems
ACCESS	Tech-enabled chronic care management; launches July 2026, relevant to systems building digital health/remote monitoring capabilities
WISeR	AI-enabled prior authorization; relevant to systems managing high utilization, active Jan 2026

Rural & Safety Net

Rural Health Transformation Program: Major federal investment for rural hospitals and CAHs, including infrastructure, AI/remote monitoring, and workforce

FCHIP: Flexible payment options for Critical Access Hospitals in frontier states

RCH Demo: Cost-based reimbursement for small rural hospitals through June 2028