Episode-Based Payments
Expert articles and analysis related to episode-based payments.
AI Summary — Last 30 Days
CMS is moving episode-based payments from voluntary experimentation toward mandatory infrastructure: the FY 2027 IPPS proposal would expand and redesign CJR nationally, while hospitals continue preparing for the mandatory TEAM model and cardiology stakeholders begin mobilizing around a mandatory heart failure episode model. The strategic signal for health systems, ACOs, post-acute providers, and payers is clear: success will depend less on isolated bundle management and more on enterprise-wide episode analytics, specialist alignment, SNF/home-health network control, and capital-light care redesign across orthopedics, surgical episodes, and medical episodes such as heart failure. The main tension is operational readiness versus policy acceleration, as CMS under the Trump administration pushes broader mandatory VBC participation while industry groups press for refinements to risk adjustment, quality measurement, overlap rules, and downside-risk protections in the FY 2027 IPPS rule and related episode models like CJR expansion.
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