Cost & Affordability
Expert articles and analysis related to cost & affordability.
AI Summary — Last 7 Days
Cost and affordability pressures are converging around tighter utilization controls and more accountable specialty care: HCTTF’s new Strive Health case study points to risk-aligned kidney care partnerships, earlier CKD/ESKD identification, and multidisciplinary care as a VBC pathway to reduce total cost of care while improving outcomes (HCTTF case study). At the same time, CMS scrutiny of Medicare Advantage billing—underscored by Elevance Health’s $342M payment amid a federal probe—signals rising compliance and revenue-risk exposure for MA plans and downstream risk-bearing providers (KFF Health News). Medicaid program-integrity disputes, ACA plan losses, and renewed prior authorization reform activity suggest payers are seeking affordability through tighter medical management and payment discipline, creating operational friction for providers even as policymakers push for more timely access and accountable care.
Related Articles
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Some Senate Democrats want to cap the amount beneficiaries in traditional Medicare have to pay toward care, but the move is expected to draw GOP opposition for potentially adding billions to Medicare ...
Families With Children Who Have Out-Of-Pocket Medical Costs At 10% Of Income Are Twice As Likely To Experience Food Insecurity As Other Households - open minds
Families With Children Who Have Out-Of-Pocket Medical Costs At 10% Of Income Are Twice As Likely To Experience Food Insecurity As Other Households open minds
More Bipartisan Agreement on Reining In Hospitals’ Anti-Competitive Practices and ‘Crushing’ Price Hikes
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Hospital drug and supply expenses push finance teams to rethink cost strategy
With drug and supply costs continuing to strain margins, hospitals are searching for strategic approaches to mitigate the impact. Drug costs are surging, driven by specialty drugs ranging from GLP-1 p...