Benchmarking & Risk
Expert articles and analysis related to benchmarking & risk.
AI Summary — Last 30 Days
CMS is moving into a more aggressive “benchmarking and risk recalibration” phase under the Trump administration, with the CY 2027 MSSP proposed rule signaling major financial methodology changes that could reshape ACO benchmark growth, shared-savings potential, forecasting, and participation strategy—especially for organizations weighing MSSP against CMMI’s new LEAD model before final methodology details are released (Wakely analysis). At the same time, ACO REACH’s strong 2024 performance—$988 million in Medicare savings despite its scheduled sunset—creates pressure on CMS and CMMI leadership to preserve or translate its risk-bearing design elements into successor models, even as MA coding-intensity scrutiny keeps risk adjustment and payment accuracy at the center of payer and provider strategy (Healthcare Dive).
Related Articles
CY 2027 MSSP Proposed Rule Analysis: What the Medicare Shared Savings Program Changes Mean for ACOs
CMS has proposed one of the most significant sets of Medicare Shared Savings Program (MSSP) financial changes in recent years. While many of the proposed changes create new opportunities for Accountab...
Your LEAD Benchmark Will Move for 10 Years. Here's How to Stay Ahead of It.
Your LEAD Benchmark Will Move for 10 Years. Here's How to Stay Ahead of It. Innovaccer
Defaults Don’t Lie: Medicare Advantage’s Approach To Pricing Risk Is Broken
Defaults Don’t Lie: Medicare Advantage’s Approach To Pricing Risk Is Broken Health Affairs
Accepted into LEAD – Now What? ACO Risk Mitigation Strategies Part 2
LEAD acceptance letters are out, the Participant TIN list is due to CMS in early August, and the financial methodology that governs how shared savings and payments work is expected later this summer. ...
Decoding Medicare Advantage Coding Intensity
Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS,...
Part B Negotiated Drug Prices: How MA Plans Should Prepare
Shifting to the left: Innovating prospective risk adjustment
Shifting to the left: Innovating prospective risk adjustment Optum Business
Week in Washington 07/16/26
CMS Payment Rule Lawsuits Congress Elevance – Elevance announced it would be exiting additional Medicaid markets in the next 12-18 months due to financial pressures and upcoming work requirements. Ele...
Soon-to-expire ACO REACH generates more savings for Medicare
The model, which is set to sunset at the end of this year, generated $988 million in savings for Medicare in 2024, according to new CMS data. That’s up from almost $695 million in savings from the yea...
Risk Adjustment Coding Deep Dive: Real‑World Insights from the Experts
Risk Adjustment Coding Deep Dive: Real‑World Insights from the Experts AAPC