Cost & Affordability

VBC strategy is increasingly shifting from broad total-cost contracts to specialty- and episode-specific affordability plays: CJR-X readiness is pushing hospitals to tighten orthopedic episode analytics and post-acute control, while kidney and GI models are positioning earlier identification, multidisciplinary care, and risk-aligned specialty partnerships as ways to reduce avoidable utilization and total cost. At the payer-provider level, health systems are finding uneven appetite for downside risk across markets, making payer clinical collaboration, data transparency, and operational alignment decisive factors in whether affordability-focused VBC contracts can scale (HFMA). Medicare Advantage remains central to the cost debate as enrollment reaches 55% of eligible beneficiaries in 2026, intensifying pressure around prior authorization reform and plan-provider accountability while CMS under the Trump administration continues to shape the operating environment for MA, ACCESS, LEAD, and other payment model strategies (KFF).