The United States healthcare system operates on a staggering paradox, where the overwhelming majority of its multi-trillion-dollar expenditure is dedicated not to preserving health but to managing diseases that could have been prevented. For decades, the national conversation has orbited around treatment, cures, and interventions that occur only after a diagnosis is made. This reactive model, often termed “sick care,” has been the financial and operational bedrock of American medicine. Now, a pivotal shift is underway as the federal government launches a landmark experiment designed to challenge this paradigm. The question is no longer just how to treat illness more effectively, but whether the system can be rewired to pay for wellness itself, fundamentally altering the financial incentives that have long guided patient care.
The $4.4 Trillion Question Why Does 90% of U.S. Healthcare Spending Go Toward Treating Preventable Illness
At the heart of this national healthcare debate is a stark and unsustainable economic reality. According to the Centers for Disease Control and Prevention, approximately 90% of the nation’s nearly $4.9 trillion annual healthcare expenditure is allocated to treating chronic and mental health conditions. Many of these ailments, including type 2 diabetes, heart disease, and certain cancers, are largely preventable through lifestyle modifications. This financial imbalance highlights a system that heavily favors intervention over prevention, rewarding complex procedures and pharmaceuticals while offering little to no reimbursement for the foundational work of keeping people healthy in the first place.
This long-standing model prioritizes what some leaders, like Abe Sutton, director of the CMS Innovation Center, have called “flashy, expensive surgeries” over the “unglamorous work of prevention.” The result is a healthcare apparatus that excels at managing advanced disease but struggles to address its root causes. This focus on reactive treatment creates a cycle of dependency on costly medical interventions, driving up costs for both the government and individuals without proportionally improving the nation’s overall health and well-being. The challenge, therefore, lies in shifting the economic incentives to favor proactive, preventative health strategies.
From Sick Care to Health Care The Government’s New Bet on Prevention
In a direct response to this systemic imbalance, the Centers for Medicare and Medicaid Services (CMS) has initiated the MAHA ELEVATE program, a groundbreaking pilot designed to test the efficacy of a wellness-first approach. This initiative represents one of the most significant efforts by the U.S. government to move beyond the traditional fee-for-service model and invest directly in preventative health. Its mission is officially threefold: to build robust evidence on the cost and quality benefits of lifestyle interventions, to empower patients with the tools to manage their own health, and to promote wellness as a means of preventing or even reversing chronic disease.
The program’s core focus is on whole-person care, targeting the underlying drivers of poor health rather than merely treating symptoms. Key interventions center on foundational lifestyle pillars that are not typically covered by traditional Medicare, including comprehensive nutritional guidance, structured physical activity programs, sleep hygiene, stress management techniques, support for avoiding harmful substances, and strategies to foster social connection. By funding projects that integrate these elements, CMS aims to generate a new body of evidence demonstrating that investing in wellness can yield significant long-term returns in both patient outcomes and financial savings.
Deconstructing the New Model How a Wellness First System Would Work
The operational blueprint for this shift is a $100 million investment designed to fund and evaluate up to 30 innovative health projects through cooperative agreements. These projects, which began rolling out in two cohorts this year and will continue into 2027, are tasked with delivering holistic care to Original Medicare beneficiaries. This funding provides the financial runway for organizations to test models of care that have long been advocated for in theory but have lacked a viable reimbursement pathway within the existing system. The initiative specifically targets services that fall outside the conventional scope of medical billing codes.
Under the ELEVATE program, the definition of “medical care” expands significantly. Foundational requirements for all funded projects include components of nutrition and physical activity, recognizing these as cornerstones of preventative health. Beyond this, the umbrella of wellness services covers a wide spectrum of interventions, from mindfulness and stress reduction coaching to sleep therapy and programs aimed at combating social isolation. This holistic approach acknowledges that health is influenced by a complex interplay of physical, mental, and social factors, and that effective care must address this complexity.
Participation is open to a diverse array of organizations, from private medical practices and large health systems to accountable care organizations and community-based groups. This broad eligibility is intended to foster innovation from different corners of the healthcare ecosystem. However, the selection process is rigorous. Applicants must demonstrate a history of providing safe and effective interventions backed by peer-reviewed research and possess the infrastructure for meticulous data collection. This strict requirement underscores the program’s primary goal: to produce unimpeachable evidence that can inform future, permanent changes to Medicare policy.
Voices from the Front Lines Expert Praise and Practical Concerns
The announcement of the ELEVATE program has been met with widespread optimism from industry leaders, many of whom view it as a long-overdue correction to the nation’s healthcare trajectory. Dr. Sanjay Doddamani, founder and CEO of Guidehealth, characterized the initiative as a “long overdue push from CMS,” highlighting its potential to validate the economic case for prevention. He argues that if these pilot programs can prove that services like nutritional coaching lower the total cost of care, it “changes the conversation about what Medicare should pay for.” This sentiment is echoed by Ann Greiner, president of the Primary Care Collaborative, who praised the program for embracing a “more holistic approach” that aligns with growing patient demand for alternatives to conventional medicine.
However, alongside the praise comes a healthy dose of skepticism focused on the practical challenges of implementation. A central concern is whether these new, progressive services can succeed when grafted onto an outdated delivery system. Sean Mehra, co-founder of HealthTap, offered a potent analogy, warning that CMS risks pouring “high-octane fuel”—funding for wellness and digital tools—into the “broken engine” of episodic, brick-and-mortar primary care. He contends that the traditional 15-minute office visit is fundamentally ill-equipped to foster the trust and continuous engagement needed to inspire lasting behavioral change.
This critique is further sharpened by Dr. Geoffrey Rutledge, who cautioned that for the model to be effective, “lifestyle medicine shouldn’t be a referral; it should be the foundation” of primary care. The danger, he noted, is that these new wellness services could become isolated, adjunct offerings rather than being fully integrated into the patient’s core care plan. For the program to realize its transformative potential, the primary care physician must evolve into a “chief coach,” using these newly funded services as essential tools to guide patients on a continuous health journey. This raises a critical question: will ELEVATE simply add another silo to the system, or will it catalyze a fundamental redesign of primary care itself?
Building the Future of Primary Care A Roadmap for Successful Implementation
Proponents of the program who acknowledge these implementation hurdles have coalesced around a proposed solution: a modernized delivery model built on technology and continuous relationships. The vision is for a system rooted in “high-frequency, low-friction virtual primary care,” one that transcends the physical and time-based limitations of the traditional clinic. In this model, lifestyle medicine ceases to be a peripheral “side dish” and instead becomes the “main course, served digitally,” making proactive health management an accessible and integrated part of a patient’s daily life.
This transformation would be powered by the integration of digital health tools and wearable technology. Data from devices like continuous glucose monitors and smart rings could provide a constant stream of actionable health insights, enabling care teams to offer personalized, real-time guidance. This technological backbone would support a fundamental shift in the doctor-patient dynamic, moving the physician from a “distant authority figure into a daily partner in health.” The ultimate goal is to build a robust “infrastructure of influence” that proves more powerful in managing chronic disease than any prescription pill alone.
Ultimately, the long-term success of this ambitious experiment hinges on the quality of the evidence it produces. Across the spectrum of expert opinion, there is universal agreement that the program must be held to the highest scientific standards. The call for applying “pharmaceutical-level rigor” to the evaluation of lifestyle interventions is a recurring theme, as robust data is seen as the only currency that can drive systemic policy change. If the MAHA ELEVATE program can deliver this definitive proof, it will provide CMS with the justification needed to permanently expand Medicare coverage for wellness services, truly reshaping the future of American healthcare.
The launch of the MAHA ELEVATE program marked a watershed moment in U.S. health policy, representing a deliberate and well-funded attempt to pivot a multi-trillion-dollar industry from treatment toward prevention. The expert consensus that emerged was one of cautious optimism, celebrating the program’s vision while soberly acknowledging the immense structural and cultural barriers it faced. The central challenge was never merely about funding new services; it was about proving their value with irrefutable data and inspiring a parallel evolution in how primary care was delivered. The program’s legacy was therefore defined not just by the outcomes of its pilot projects, but by whether it successfully laid the evidentiary groundwork for a healthcare system that finally paid to keep people well.
