Healthcare Affordability
Expert articles and analysis related to healthcare affordability.
AI Summary — Last 30 Days
VBC affordability strategy is shifting deeper into specialty and episode-based accountability, with CMMI-linked models such as CJR-X, LEAD, ACCESS, and chronic-condition episodes pushing providers to manage total cost beyond primary care—especially post-acute utilization, procedures, and longitudinal specialty spend. At the same time, health systems are finding uneven payer readiness for downside risk, creating a strategic divide between markets where payers co-develop clinical cost-reduction infrastructure and markets where providers must shoulder more actuarial and operational risk themselves. Medicare Advantage remains central to the affordability tension: with MA enrollment reaching 55% of eligible beneficiaries in 2026, prior-authorization scrutiny—particularly for LTAC and inpatient rehab—raises the stakes for post-acute network management, access protections, and VBC contract design (KFF MA trends; HFMA on payer risk).
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