Cost Containment & Affordability
Expert articles and analysis related to cost containment & affordability.
AI Summary — Last 30 Days
Synthesis: In the past 30 days, CMS has signaled a decisive return to mandatory episode-based payment with the launch of the Transforming Episode Accountability Model (TEAM), marking a major structural realignment toward bundled payments as a lever for Medicare cost containment and affordability. TEAM, which imposes new financial and quality risk on hospitals—including a 2% payment discount for LEJR, SHFFT, and spinal fusion episodes—requires health systems to rapidly reassess surgical care operations, margin management, and post-acute strategy The TEAM Bundle: Where Hospitals Will Win and Lose. Meanwhile, finalized updates to the Part D risk adjustment model for 2027 are set to further differentiate plan payments between MA-PDs and PDPs, introducing new competitive pressures and shifting incentives for plans managing high-cost populations 2027 Part D Risk Adjustment Changes. These measures, coupled with mixed financial results from recent value-based oncology pilots, point to intensified focus on structural payment redesigns as central to the Trump administration’s VBC and affordability strategy.
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