CMS Programs & Policy
Expert articles and analysis related to cms programs & policy.
AI Summary — Last 30 Days
CMS payment-model strategy is shifting from broad VBC participation toward sharper risk selection and infrastructure readiness: ACOs accepted into the CMMI LEAD Model now face near-term decisions on Participant TINs, MSSP overlap, stop-loss protection, and downside-risk exposure before final methodology details arrive later this summer (Wakely on LEAD risk mitigation). At the same time, Medicare Advantage payment accuracy remains under pressure as scrutiny intensifies around coding intensity, Star Ratings litigation/recalculations, and a 2026 Quality Bonus Program projected to exceed $13 billion—creating parallel headwinds for plans and provider groups dependent on MA revenue and quality-driven bonuses (KFF on MA quality bonuses). For VBC leaders, the strategic divide is widening between organizations with the data, actuarial, and care-management infrastructure to manage attribution, quality, and total cost of care—and those likely to retreat to MSSP or lower-risk arrangements as CMS under the Trump administration continues to test more accountable payment models.
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