CMMI Payment Models
Expert articles and analysis related to cmmi payment models.
AI Summary — Last 30 Days
CMS/CMMI is signaling a broader Trump administration push to expand model-based payment beyond traditional ACO constructs: the ACCESS model is being widened for 2027 to include COPD, substance use disorder, and tobacco cessation, while officials are emphasizing cross-payer alignment and technology-enabled chronic care management (ACCESS expansion). At the same time, CMMI is moving into more assertive utilization-management territory, with CMMI Director Abe Sutton positioning the WISeR Medicare prior authorization pilot as a potential template for other federal programs—creating a strategic tension for providers between accepting more downside-risk/accountable-care opportunities and managing increased federal scrutiny over “wasteful” services (WISeR model). For ACOs, hospitals, specialists, and post-acute providers, the near-term positioning question is how to align capabilities across primary care, specialty episodes, home health, data/AI infrastructure, and Medicaid/Medicare models as CMS pushes payment innovation into more conditions, sites of care, and utilization controls.
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