Cost, Quality, & Utilization
Expert articles and analysis related to cost, quality, & utilization.
AI Summary — Last 30 Days
Over the past 30 days, CMS under the Trump administration has accelerated the shift to mandatory, episode-based payment models with the proposed CJR-X and Transforming Episode Accountability Model (TEAM), moving beyond voluntary participation to require broad hospital accountability for costs and outcomes tied to joint replacements and other major surgical episodes starting in 2027. This revival and expansion of bundled payments signals a structural pivot from the growth of Medicare Advantage back toward fee-for-service transformation, intensifying pressures on hospitals and post-acute providers to coordinate care and control post-discharge utilization, as well as raising operational risks for those unprepared for bundled payment's performance demands (bundled payments are back, CMS proposes mandatory hospital-bundled model for joint replacements). At the same time, ACOs and population health entities are working to counter network leakage and strengthen their value-based infrastructure, as seen in new technology solutions targeting care delivery fragmentation.
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just 5% of GDP, and a remarkable 48% of health spending was out of pocket by individual patients.
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