Medicare & CMS Programs
Expert articles and analysis related to medicare & cms programs.
AI Summary — Last 7 Days
CMS’s value-based care agenda is shifting toward more explicit downside-risk readiness: the LEAD ACO model is drawing attention to structural limits of fee-for-service-based VBC, post-acute data visibility, and actuarial modeling needs as ACOs evaluate whether they can manage longitudinal cost and quality risk under the Trump administration’s CMS. Medicare Advantage remains a parallel pressure point, with the finalized MA payment increase for 2027 and renewed RADV extrapolation concerns sharpening plan focus on coding accuracy, audit exposure, and star-rating economics. Meanwhile, specialty models are showing mixed but important signals for scalable VBC—Interwell’s Kidney Care Choices results reinforce the savings-and-quality case for condition-specific accountability, while GUIDE and episode-based strategies suggest continued market investment in targeted CMS model participation ([LEAD model implications](https://news.google.com/rss/articles/CBMiuwFBVV95cUxNVDVERXE5YnNvMHZmTElIMWRkampsUjQ0UDk3WV9PWFBPQWdrNzFWaTVDaUxjb290MHJvYmgxV29EN0R0QkU5SE5CaUMyMEFDX3BMblhVVnRmV2FLV00zNGZENm5SYlNXOTh4UHZGaWZ5Skc3V2tWOG9zM0w2NF9JU3dHWTlGMl
Related Articles
STAT+: Trump’s obesity drug plan creates a temporary Medicare program that may be hard to end
After July 1, Medicare will offer GLP-1 weight-loss drugs for $50. It's supposed to be temporary, but chances are it won't be.
STAT+: CMS recalculates Medicare Advantage star ratings again, adding more volatility to program
Medicare Advantage plans that receive four out of five stars or better get bonus payments, which have ballooned to $16 billion this year.
How CMMI’s Mission Remains the Same Despite Changes in Leadership
How CMMI’s Mission Remains the Same Despite Changes in Leadership NEJM Catalyst Innovations in Care Delivery
How MCOs Should Be Preparing for the OBBBA's Medicaid Cuts: David Brueggeman, MBA
Changes in Medication Use After Medicare Part D Annual Out-of-Pocket Spending Caps
Changes in Medication Use After Medicare Part D Annual Out-of-Pocket Spending Caps JAMA
Changes in Medication Use After Medicare Part D Annual Out-of-Pocket Spending Caps
Changes in Medication Use After Medicare Part D Annual Out-of-Pocket Spending Caps JAMA
State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act
State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act RAND
OIG Publishes Medicare Advantage Industry-Specific Guidance
OIG Publishes Medicare Advantage Industry-Specific Guidance JD Supra
OIG report raises red flags about maternal health 'ghost networks' in Medicaid managed care
OIG report raises red flags about maternal health 'ghost networks' in Medicaid managed care Fierce Healthcare
MedPAC to Congress: Here’s how to rework Medicare’s misaligned incentives
MedPAC to Congress: Here’s how to rework Medicare’s misaligned incentives Medical Economics