Healthcare Affordability
Expert articles and analysis related to healthcare affordability.
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CMS is pushing affordability through payment-model and administrative levers: the agency is advancing a Medicaid drug payment model aimed at lowering drug costs while tightening prior authorization transparency requirements across Medicare Advantage, Medicaid managed care, and ACA marketplace plans—moves that increase pressure on payers and risk-bearing providers to document access, utilization management, and total-cost impact. At the same time, evidence scrutiny is intensifying around high-cost care redesign: Mathematica’s joint-replacement analysis reinforces the durability of episode-based savings when quality is protected, while PHTI’s finding that virtual CKD programs have not reduced progression or spending challenges population-health vendors and ACOs to prove ROI before scaling digital disease-management contracts. For VBC stakeholders, the strategic tension is shifting from broad “innovation” adoption to measurable affordability—drug rebates, transparent utilization controls, episode performance, and evidence-backed digital care models will increasingly determine which partnerships and care pathways survive. CMS Medicaid drug payment model
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