CMS Payment Models
Expert articles and analysis related to cms payment models.
AI Summary — Last 30 Days
CMS is pushing a broader VBC portfolio under the Trump administration, with CMMI advancing the Long-Term Enhanced ACO Design (LEAD) model to expand accountable care participation while also launching the 10-year ACCESS model, which accepted 150 participants and ties Medicare payment for chronic conditions such as obesity, diabetes, musculoskeletal pain, and depression to measurable outcomes enabled by technology partners (ACCESS participants). The strategic signal for ACOs, physician groups, and payers is a shift toward scalable, tech-enabled population health models with lighter upfront participation barriers, but with increasing accountability for outcomes, data infrastructure, and specialty/chronic disease performance. At the same time, CMS’s proposed resurrection and nationwide expansion of the mandatory CJR-X bundled payment model points to renewed interest in mandatory episode-based accountability, creating tension between voluntary growth models like LEAD/ACCESS and compulsory hospital-led bundles that require tighter post-acute and home health coordination (CJR-X proposal).
Related Articles
Policy Expert Believes CMS is Taking "Adversial Posture" to Medicare Advantage
Policy Expert Believes CMS is Taking "Adversial Posture" to Medicare Advantage MedCity News
ALYKA Health selected as a participant in Medicare ACCESS Model, expanding access to value-based digital health
ALYKA Health selected as a participant in Medicare ACCESS Model, expanding access to value-based digital health Weekly Voice
Care delays and denials grow across 6 states using WISeR Model, lawmaker says
Traditional Medicare denials are harming patient care in the six states where the U.S. Centers for Medicare & Medicaid Services mandated the use of the Wasteful and Inappropriate Service Reduction (WI...
Aetna agreed to pay $117.7 million in Medicare Advantage false claims settlement
Aetna agreed to pay $117.7 million in Medicare Advantage false claims settlement MSN
Does Medicare Advantage Rate Relief And Delay Resets The Bull Case For UnitedHealth Group (UNH)?
Does Medicare Advantage Rate Relief And Delay Resets The Bull Case For UnitedHealth Group (UNH)? Sahm
Trump admin proposes Medicare Advantage ratings overhaul
Trump admin proposes Medicare Advantage ratings overhaul MSN
FY 2027 Skilled Nursing Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating for FY 2027 the Medicare skilled nursing facility (SNF) payment rates, SNF Quality Reporting Program and the SNF Value-Based Purchasing P...
FY 2027 Hospice Payment Rate Update Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating the Medicare hospice payment rates, wage index and Hospital Quality Reporting Program for FY 2027. The post FY 2027 Hospice Payment Rate ...
CMS Finalizes CY 2027 Medicare Advantage and Part D Rule: Key Implications for Plan Sponsors
CMS Finalizes CY 2027 Medicare Advantage and Part D Rule: Key Implications for Plan Sponsors Crowell & Moring LLP
Does Medicare Advantage Rate Relief And Delay Resets The Bull Case For UnitedHealth Group (UNH)? - simplywall.st
Does Medicare Advantage Rate Relief And Delay Resets The Bull Case For UnitedHealth Group (UNH)? simplywall.st