Bundled Payments & Capitation
Expert articles and analysis related to bundled payments & capitation.
AI Summary — Last 7 Days
Over the past week, CMS has advanced a bold expansion of mandatory bundled payments with the proposed CJR-X model, which would obligate nearly all hospitals nationwide to manage episode-based costs for lower joint replacements across inpatient, skilled nursing, and home health settings starting October 2027—a move designed to foster tighter hospital-post acute care coordination and accelerate value-based transformation CMS proposes mandatory hospital-bundled model for joint replacements. At the same time, CMS finalized 2027 Medicare Advantage capitation rates featuring a 2.48% average increase, directly impacting risk-bearing payers and providers’ revenue forecasts and signaling ongoing federal commitment to capitation as a lever for population health and cost containment 2027 MA Capitation Rates and Payment Policies. These actions mark a notable tightening of federal policy around provider accountability and signal intensifying expectations for cross-continuum care coordination and financial integration in Medicare 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
CMS proposes hospital pay bump, revived joint replacement model
CMS proposes hospital pay bump, revived joint replacement model  Modern Healthcare
CMS Announces 2027 MA Capitation Rates and Parts C and D Payment Policies
Announcement of Calendar Year (CY) 2027 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2027 Rate Announcement)
From newsletter: Chris Klomp joins HTN to discuss the 2027 MA Final Notice Chris Klomp joins HTN to discuss the 2027 MA Final Notice We discuss the implications of CMS finalizing an expected average c...
The LEAD Model: A New Chapter in Medicare Accountable Care
This Wakely white paper presents the LEAD (Long-term Enhanced ACO Design) Model as CMS’s next-generation approach to accountable care, distinguished from ACO REACH and MSSP by several key structural a...