CMS Payment Models
Expert articles and analysis related to cms payment models.
AI Summary — Last 7 Days
CMS payment model attention is shifting toward more targeted, accountable models: the new LEAD model appears to extend core REACH concepts while creating a clearer participation lane for home health agencies, reinforcing CMMI’s interest in longitudinal care management, home-based capabilities, and specialist/primary care alignment (McKnight’s Home Care). At the same time, Medicaid ACO experience in maternal health points to the operational reality that population-health gains depend on care coordination, community partnerships, and data infrastructure—not just attribution and shared-savings mechanics (Milbank Memorial Fund). For VBC leaders, the week’s pattern is clear: CMS and state purchasers are continuing to broaden accountable care beyond traditional Medicare ACOs, while risk adjustment scrutiny in Medicare Advantage and major settlement activity keep compliance, coding integrity, and model governance central to strategy.
Related Articles
Humana exits affect 600,000 members - brokers have weeks to act
Humana exits affect 600,000 members - brokers have weeks to act Insurance Business
What Comments Reveal About CMS’ Proposed Medicare Home Health Rule
The comment window for the proposed CY2027 Medicare home health rule has closed — and the difference in quantity and quality from last year feels stark. Last year, the home health community flooded ...
MedPAC’s Spending Comparison Undercounts the Value of Medicare Advantage
MedPAC’s Spending Comparison Undercounts the Value of Medicare Advantage Better Medicare Alliance
Medicare is Changing in 2027: 8 Things That Will Impact Your Wallet
Medicare is Changing in 2027: 8 Things That Will Impact Your Wallet Kiplinger
Conflicting CMS Guidance and Federal Statutory Requirements Cost Medicare $380 Million Over a 6-Year Period for Organs Not Transplanted Into Medicare Enrollees - oig.hhs.gov
Conflicting CMS Guidance and Federal Statutory Requirements Cost Medicare $380 Million Over a 6-Year Period for Organs Not Transplanted Into Medicare Enrollees oig.hhs.gov
Medicare Removes Homelessness & Housing Instability Codes From Higher-Payment Hospital Classification - open minds
Medicare Removes Homelessness & Housing Instability Codes From Higher-Payment Hospital Classification open minds
ACS Advocacy Builds Momentum for Medicare Payment Reform
ACS Advocacy Builds Momentum for Medicare Payment Reform The American College of Surgeons
Medicare spent hundreds of millions of dollars on ineligible drugs, audit finds
Shoddy CMS oversight is to blame, and the agency needs to do better, the HHS Office of the Inspector General said. The CMS concurred.
A Breakthrough for Breakthrough Device Coverage? CMS Releases the RAPID Coverage Pathway Proposed Notice
A Breakthrough for Breakthrough Device Coverage? CMS Releases the RAPID Coverage Pathway Proposed Notice King & Spalding
CMS Oversight Did Not Prevent Medicare Part D Sponsors From Making $587.7 Million in Ineligible Payments to Pharmacies for Drugs Available Over the Counter but Labeled as Prescription-Only - Office of Inspector General (.gov)
CMS Oversight Did Not Prevent Medicare Part D Sponsors From Making $587.7 Million in Ineligible Payments to Pharmacies for Drugs Available Over the Counter but Labeled as Prescription-Only Office of ...