APM Models
Expert articles and analysis related to apm models.
AI Summary — Last 7 Days
CMS’ APM agenda is drawing concentrated pushback around mandatory episode models, especially CJR-X and TEAM, with AHA, Premier, NAACOS, MedPAC-facing stakeholders, and post-acute/therapy groups pressing for changes to risk design, quality measurement, hospital underpayment assumptions, and the treatment of therapy services in joint replacement episodes. At the same time, ACO risk management is becoming more sophisticated: Wakely is framing stop-loss as a key tool for MSSP and CMS Innovation Center LEAD participants taking downside risk, while Forvis Mazars emphasizes data-driven episode management as essential to succeeding under CJR-X. A parallel congressional move to block CMS’ WISeR Medicare AI prior authorization pilot signals a broader constraint on the Trump administration’s experimentation: stakeholders may support payment innovation, but they are increasingly challenging models perceived to add operational burden, opaque utilization controls, or unmanaged financial risk (Healthcare Dive).
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