Bundled Payments & Capitation
Expert articles and analysis related to bundled payments & capitation.
AI Summary — Last 30 Days
Over the past 30 days, CMS has accelerated structural shifts toward mandatory episode-based and population-level payment models, with the proposed nationwide CJR-X bundle obligating hospitals to manage total Medicare spending for joint replacements across acute and post-acute settings, intensifying hospital accountability for cost, quality, and care coordination with home health and skilled nursing providers (CJR-X model details). Simultaneously, the LEAD Model introduces a new generation of capitation for Medicare ACOs, eliminating rebasing, expanding specialist risk-sharing, and pushing deeper integration of primary-specialty care—signaling CMMI's intent to drive population health management at greater scale and financial risk (LEAD Model analysis). These moves underscore rising tensions as health systems, ACOs, and payers face increasing downside risk, narrower financial margins, and the need for robust partnerships across the care continuum to succeed under value-based care.
Related Articles
CMS’ Proposed New CJR Model Aims to Drive Hospital, Skilled Nursing Coordination Nationwide
CMS’ Proposed New CJR Model Aims to Drive Hospital, Skilled Nursing Coordination Nationwide  Skilled Nursing News
CMS Proposes Expanded CJR Model, Calls For Hospital-Home Health Coordination
CMS FY27 rule expands bundled payments, adjusts Medicare inpatient reimbursement rate
For the first time, a value-based payment model is set to become mandatory for almost all hospitals nationwide. The expansion of the Comprehensive Care for Joint Replacement (CJR) bundled payment mode...
CMS proposes mandatory hospital-bundled model for joint replacements
CMS is proposing a mandatory, nationwide episode-based payment model for joint replacements that would hold most hospitals responsible for Medicare spending tied to a patient’s surgery and recovery. ...
Under Global Budgets, Hospital Utilization In Maryland Decreased By 11 Percentage Points More Than In Other States, 2013–23
Under Global Budgets, Hospital Utilization In Maryland Decreased By 11 Percentage Points More Than In Other States, 2013–23  Health Affairs
Oncology Care Model Sees Net Losses Despite Spending Reductions
Oncology Care Model Sees Net Losses Despite Spending Reductions  National Today
Oncology Care Model’s Net Losses Well Exceed Savings
Oncology Care Model’s Net Losses Well Exceed Savings  Medscape
Rethinking Medicare’s Bundled Payment Model For Opioid Treatment Programs
Rethinking Medicare’s Bundled Payment Model For Opioid Treatment Programs  Health Affairs
bundled payment models
From newsletter: The TEAM Bundle Part 1: Where Hospitals Will Win and Lose Under Medicare’s Biggest Surgical Payment Overhaul The TEAM Bundle Part 1: Where Hospitals Will Win and Lose Under Medicare’s...
Bundled Payments Are Back – And This Time, Hospitals May Not Be Ready
For several years, bundled payment models appeared to be receding into the background, overshadowed by the rapid expansion of Medicare Advantage and Medicaid supplemental payment programs. That is now...