Cost & Affordability

VBC strategy is shifting from broad participation to targeted affordability levers: health systems are negotiating payer-specific downside-risk arrangements based on whether plans can support joint clinical redesign, while specialty models in kidney and GI care are positioning earlier identification, multidisciplinary coordination, and avoidable-utilization reduction as the next cost-control frontier. Medicare remains the central battleground, with MA now covering 55% of eligible beneficiaries and stakeholders pressing to modernize prior authorization, even as CMMI models such as ACCESS, LEAD, and CJR-X expose persistent tradeoffs around benchmarking, post-acute visibility, data infrastructure, and provider accountability. For ACOs and health systems, the near-term strategic imperative is to build payer-by-payer operating models that can manage specialty and post-acute spend, not just primary-care attribution, as affordability pressure intensifies across MA, commercial risk, and federal payment models (HFMA on payer risk appetite; HCTTF on value-based kidney care).