Managed Care Programs
Expert articles and analysis related to managed care programs.
AI Summary â Last 30 Days
CMS is signaling a managed-care and VBC agenda that pairs safety-net payment innovation with tighter drug-cost experimentation: the ACCESS framing positions safety-net providers as scalable participants in accountable care, while the GENEROUS Medicaid drug model is drawing enough manufacturer and state interest that CMS extended application timelines, even as KFF cautions that savings depend heavily on confidential rebate mechanics and uncertain model design. At the same time, operational risk is rising around utilization management and AIâmost visibly in reports that a Medicare AI prior authorization pilot delayed procedures in Washington from roughly two weeks to four-to-eight weeksâcreating a strategic tension for ACOs, MA plans, Medicaid MCOs, and providers between administrative efficiency, access, and quality accountability. Evidence from legacy CMMI models remains relevant: new findings that the Oncology Care Model reduced chemotherapy use and Medicare spending in poor-prognosis cancers reinforce the long-term case for episode-based specialty VBC, but also raise the bar for future models to prove savings without creating access friction or under-treatment concerns (KFF on GENEROUS; Healthcare Dive on AI prior authorization).
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