“We are excited about the prospect of this more comprehensive approach,” said Ann Greiner, president and CEO of the Primary Care Partnership.
“CMS ultimately provides the ‘fuel’ — funding nutrition, stress management and wearables — but if we pour this high-octane fuel into the existing ‘broken engine’ of intermittent brick-and-mortar care, it’s not going to work,” said Sean Mehra, co-founder and CEO of virtual primary care company HealthTap.
“CMS’s push to move away from pure disease care and toward a focus on prevention payment is long overdue,” said Dr. Sanjay Doddamani, founder and CEO of Guidehealth.
These are responses to the MAHA ELEVATE (Making America Healthy Again: Improving Lifestyles and Evaluating Value-Based Approaches through Evidence) model announced by the Centers for Medicare and Medicaid Services in December. Through the program, the government will invest approximately $100 million in three-year cooperative agreements to support up to 30 projects focused on the health and prevention of traditional Medicare beneficiaries.
The proposals would focus on “whole-person care approaches” such as functional medicine and lifestyle medicine, including nutrition and physical activity that are not currently covered by traditional Medicare.
“For decades, health policy has focused too much on flashy, expensive procedures and too little on tedious prevention efforts. … MAHA ELEVATE is a first-of-its-kind initiative to test evidence-based approaches to treating health problems before they become emergencies. … These programs will support innovative care that works alongside traditional medicine to prevent disease and improve quality of life at no additional cost to people,” said Abe Sutton, director of the Centers for Medicare and Medicaid. Innovation, in a statement.
Several experts said the model addresses a long-standing gap.
Greiner of the Primary Care Collaborative (PCC) said the ELEVATE approach is about giving people what they want.
“People are looking for 'alternative ways' to stay healthy or get healthy that aren't necessarily in traditional settings,” she said.
For at least one healthcare executive, however, the ELEVATE program was “in the right direction,” but difficult to implement effectively.
“You simply can’t build the trust needed to change lifelong habits with a rushed 15-minute visit once a year,” said HealthTap’s Mehra. “The impact will depend entirely on whether we use this funding to build a new delivery framework based on high-frequency, low-friction virtual primary care.”
What is the procedure?
The ELEVATE program is the first innovation center model focused on “a proactive, holistic, patient-centered functional or lifestyle medicine approach that supports traditional care.” Key areas include nutrition, physical activity, sleep, stress management, avoidance of harmful substances and social connection.
Recipients of the funds will be organizations that provide whole-person functional or lifestyle medicine services or that partner with organizations that provide these services. They may include private practices, health systems, accountable care organizations, academic organizations, and community organizations. All proposals must include nutrition or physical activity, and three of the awards will focus on dementia-specific interventions.
“To be selected, applicants must demonstrate that they or their partners have extensive experience implementing these interventions and that these interventions are safe and effective for the target populations and supported by peer-reviewed literature,” the announcement states. “In addition, they must demonstrate experience in data collection or the ability to collect and report data accurately and in a timely manner, with appropriate beneficiary safeguards in place.”
The ELEVATE program has three main goals:
- Building the Evidence: Generating cost and quality data on the effectiveness of lifestyle-centered, whole-person care in Original Medicare
- Empowering patients: Helping people take control of their health through nutrition, physical activity and mental health interventions
- Promoting health: Preventing, slowing or reversing disease by supporting behavioral changes that improve overall health
CMS will publish a notice of funding opportunities in early 2026, which will explain how organizations can apply for the ELEVATE model. The agreements will be awarded to two groups in two rounds, with the first starting in 2026 and the second in 2027.
What industry leaders say
Guidehealth's Dodamani believes the model's impact will depend largely on the evidence it can build on.
“If CMS can show that things like working with a nutrition coach, taking tai chi classes to control balance and blood pressure, or a structured lifestyle program can actually improve outcomes and reduce overall costs, that will change the conversation about what Medicare should pay for. The real value is that it will move prevention from philosophy to data to payment,” he said.
The Primary Care Partnership's Greiner is particularly excited about what the ELEVATE model means for primary care, noting that less than 1 percent of NIH funding goes to primary care.
“There are a lot of things that we expect primary care to do, and we keep asking primary care to do more and more, but we pay less than five cents on the dollar for primary care. Our system is biased in many ways. So I think this represents the potential to test some new models that might have evidence,” she said.
She added that for the scheme to be successful, the evidence supporting the innovations selected for the scheme needs to be highly transparent and a rigorous process is needed to assess its effectiveness. The same rigor as for drug testing should be applied to the ELEVATE model.
Another health executive believes the model's success will depend on its ability to attract and retain patients.
“If these interventions are viewed as separate 'items' rather than tools in a physician's bag, they will fail,” said Dr. Geoffrey Rutledge, co-founder and chief medical officer of HealthTap. “Primary care physicians must be the 'head coaches' in guiding patients using these newly funded tools. … A significant weakness of the model described is that it risks becoming an 'adjunct' to primary care rather than the core. Lifestyle medicine should not be a referral; it should be the foundation.”
He added that the model will be most effective by using mobile apps to streamline contact with primary care physicians and by integrating wearable devices such as Oura rings or continuous glucose monitors to provide actionable health guidance.
Ultimately, Rutledge's colleagues say, lifestyle should not be viewed as a “side dish.”
“This has to be the main course, delivered digitally,” said HealthTap’s Mehra. “The future of chronic disease management isn’t better pills, it’s better relationships. We need to fund impact infrastructure — mobile-first platforms that transform physicians from distant authority figures into everyday partners in health.”
That could upend perceptions of the U.S. health care system, which is often described as a “sickness care model,” meaning it primarily treats people after they get sick or injured, leading to higher costs. Contrary to the healthcare model, which prioritizes prevention through early screening and other tools.
In fact, according to the Centers for Disease Control and Prevention, approximately 90% of the approximately $4.9 trillion in annual U.S. health care spending is spent on people with chronic and mental illness, many of which are preventable or better managed through early intervention.
Photo: Halfpoint Images, Getty Images
