Healthcare Market Dynamics

The Trump administration’s CMS is simultaneously tightening the Medicare Advantage risk-adjustment environment and keeping the market investable, with a finalized 2.48% MA payment increase for 2027 helping plans such as UnitedHealthcare project a more competitive posture even as plan exits and benefit redesigns remain likely. At the same time, the $542M DOJ settlement against Humana-owned The Villages Health for alleged fabricated MA diagnosis codes underscores that VBC organizations dependent on coding intensity face rising enforcement and diligence risk, especially in provider-owned or aligned MA models (Healthcare Dive).

CMMI’s ACCESS model is emerging as a key signal of where Dr. Mehmet Oz’s CMS and Abe Sutton’s CMMI may steer care delivery transformation: toward AI-enabled, tech-augmented chronic care management, with Oura, Counsel Health, and Aledade positioning around wearables, virtual care, and scalable population health workflows (Fierce Healthcare). The strategic tension for ACOs, payers, and enablement companies is whether these tools can produce measurable utilization and cost outcomes—particularly as assessments like PHTI’s CKD review question whether virtual chronic care solutions actually slow disease progression or reduce spend.