Medicare & Medicaid Programs
Expert articles and analysis related to medicare & medicaid programs.
AI Summary — Last 7 Days
CMS’s value-based care agenda this week is tilting toward more mandatory, episode-based accountability while tightening oversight in Medicare Advantage: the new/expanded CJR-X joint replacement model is drawing operational focus on data, episode economics, and provider readiness, while commentary on LEAD underscores the continuing limits of layering VBC incentives on fee-for-service architecture. At the same time, MA plans face compounding revenue and compliance uncertainty from CMS recalculating 2026 Star Ratings and heightened scrutiny around RADV extrapolation and OIG MA guidance—raising the stakes for risk adjustment governance, quality operations, and bid strategy. For health systems and ACOs, the signal is clear: prepare for more procedure-specific downside risk and stronger federal enforcement around coding, quality, and model performance under the Trump administration’s CMS. CJR-X analysis | RADV guide
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