Cost of Care
Expert articles and analysis related to cost of care.
AI Summary — Last 30 Days
Cost-of-care strategy is shifting from broad VBC participation toward tighter control of specialty, post-acute, and avoidable-utilization economics: CJR-X and LEAD preparation are pushing providers to build episode-level data, discharge visibility, and post-acute performance management, while kidney and GI models are emphasizing earlier identification, multidisciplinary care, and risk-aligned specialty integration to reduce total cost of care. Health systems also face uneven payer appetite for downside risk—some plans are partnering clinically to reduce low-value care, while others remain contract-focused—creating a market-by-market strategy problem for ACOs and provider-led VBC organizations. Meanwhile, Medicare Advantage remains a dominant cost-of-care arena, with 55% of eligible beneficiaries enrolled in MA in 2026 and quality bonus spending projected above $13 billion, intensifying scrutiny of whether MA’s growth and incentives are translating into real affordability gains for CMS, plans, and providers (KFF MA trends; HFMA on payer risk).
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