Cost & Affordability
Expert articles and analysis related to cost & affordability.
AI Summary â Last 7 Days
Affordability pressure is shifting from broad VBC rhetoric to sharper payment and network design fights: KFF estimates that new 2025 reconciliation-law limits could reduce Medicaid hospital state directed payments across at least 37 states, putting hospital finances, Medicaid managed care rates, and safety-net VBC arrangements on a collision course with state budget constraints (KFF analysis). At the same time, payers are tightening utilization and network managementâKFF found at least 1 in 8 standard prior authorization requests denied across Medicare Advantage, Medicaid managed care, and ACA marketplace plansâwhile specialty VBC players such as Strive Health are positioning âhigh-valueâ kidney networks around measurable outcomes and total-cost performance rather than broad access alone (Strive Health). The through line for ACOs, health systems, and payer strategists is that cost containment is increasingly being operationalized through payment caps, narrower networks, and administrative controls, raising the stakes for demonstrable quality, avoidable-utilization reduction, and provider alignment.
Related Articles
Hospital Price Transparency After Five Years: The Next Challenge Is Incentives, Not Disclosure
Hospital Price Transparency After Five Years: The Next Challenge Is Incentives, Not Disclosure  Health Affairs
Value-based Care Can Make Healthcare More Affordable for Patients
Value-based Care Can Make Healthcare More Affordable for Patients  EIN News
Premiums, Out-of-Pocket Costs Top Americans' Health Concerns
Blog explains how value-based care can make healthcare more affordable
Blog explains how value-based care can make healthcare more affordable  American Hospital Association
Value-based Care Can Make Healthcare More Affordable for Patients
Value-based Care Can Make Healthcare More Affordable for Patients  American Hospital Association
Same Knee Surgery, Twice the Price: Hospital Monopolies Push Up Healthcare Costs
From newsletter: HealthWeek406: AI's Role in Rural Healthcare HealthWeek406: AI's Role in Rural Healthcare Plus, Libby's Center for Asbestos Related Disease has permanently closed. Í Í Í Í Í Í Í Í Í Í...
Report: Employersâ Use of Big Three PBMs Falls in 2026
A new survey finds that employers are moving away from the Big Three PBMs while prioritizing healthcare affordability and transparency. The post Report: Employersâ Use of Big Three PBMs Falls in 2026 ...
$50 Billion Wonât Fix Rural Maternity Care Without State Reform
To address maternal care shortages, states should use new federal funding to expand access to lower-cost settings that provide safe, high-quality care. The post $50 Billion Wonât Fix Rural Maternity C...
Why diagnostics are becoming healthcareâs next cost challenge
Why diagnostics are becoming healthcareâs next cost challenge  Becker's Hospital Review
New Cato report excoriates certificate of need laws
The libertarian think tank analyzed almost 130 studies digging into the controversial laws, which require providers to get state approval before building facilities or adding new services. What it fou...