Cost of Care
Expert articles and analysis related to cost of care.
AI Summary ā Last 7 Days
Cost-of-care pressure is concentrating in pharmacy, MA, and referral management: CMSās finalized GLOBE Drug Payment Model and growing interest in value-based pharmacy reimbursement signal a push to tie drug spending more directly to outcomes, while 2027 MA Star Ratings mean more than 70% of MA-PD members are in 4+ star contracts that will receive quality bonuses and higher 2028 rebatesāraising stakes for plansā benefit design, medication adherence, and total-cost management (HFMA). At the same time, MA plan availability is tightening unevenly by county as some major insurers retrench, creating local market disruption for ACOs, health systems, and payer partners trying to manage populations under risk (KFF). On the provider side, examples like Privia NTās reported 45% referral-cost reduction underscore a broader VBC operating theme: specialty referral governance and ambulatory specialty models are becoming central levers for chronic disease cost containment and ACO/MIPS performance.
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