Cost & Affordability
Expert articles and analysis related to cost & affordability.
AI Summary — Last 30 Days
CMS is moving affordability policy back toward more explicit downside-risk and episode accountability: the proposed mandatory, nationwide CJR-X model would make most hospitals accountable for Medicare spending across hip, knee, and ankle replacement episodes beginning Oct. 1, 2027, with implications for post-acute networks, home health coordination, and specialist alignment (Hall Render). At the same time, CMS is testing a different cost-control thesis through the voluntary ACCESS model, selecting more than 150 participants to pair providers with technology companies and tie payment to chronic disease outcomes—signaling that the Trump administration’s CMS is pursuing both mandatory bundles for high-cost procedures and tech-enabled longitudinal management for chronic illness (CMS ACCESS participants). For health systems, ACOs, and payers, the strategic tension is shifting from whether value-based care will expand to which capabilities will matter most: episode cost control, post-acute steerage, specialty integration, data/AI infrastructure, and proof that VBC models can generate measurable Medicare savings without eroding access or quality.
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