Medicare Payment Models
Expert articles and analysis related to medicare payment models.
AI Summary — Last 24 Hours
CMS’s July 14 methodology update to the Long-term Enhanced ACO Design (LEAD) Model is forcing ACOs to re-underwrite PY 2027 participation, with revised benchmarks, regional adjustment mechanics, beneficiary alignment rules, and TIN strategy changing the relative economics of Professional Risk vs. other tracks (Wakely analysis). At the same time, hospitals facing the mandatory TEAM episode-payment model are being pushed to quantify margin opportunities from care redesign, post-acute management, and episode leakage reduction, while Indiana’s planned Medicaid GLP-1 coverage under the BALANCE model signals that state Medicaid value-based models may increasingly test obesity-drug access tied to population-health goals. Together, the last 24 hours point to a broader Trump CMS/CMMI posture under Dr. Mehmet Oz and Abe Sutton: payment models are not slowing down, but participants will need sharper actuarial, attribution, and specialty-cost management capabilities to protect downside-risk economics.
Related Articles
CMS Rewrites the LEAD Model Business Case: What ACOs Must Recalculate for PY 2027
How the July 14 Long-term Enhanced Accountable Care Organization (ACO) Design (LEAD) Model methodology update changes ACO benchmarks, risk-track decisions, beneficiary alignment, and Tax Identificatio...
Rainfall Health Outlines Multi-Million Dollar Opportunity for Hospitals Impacted by CMS TEAM Mandate
Rainfall Health Outlines Multi-Million Dollar Opportunity for Hospitals Impacted by CMS TEAM Mandate  AOL.com
Medicare physician fee schedule proposal includes changes to G2211, other codes - American Academy Of Family Physicians | AAFP
Medicare physician fee schedule proposal includes changes to G2211, other codes  American Academy Of Family Physicians | AAFP
Medicare Advantage’s 2027 pay raise was set at 2.48%, and insurers are expected to trim extra perks in response. - NewsBreak: Local News & Alerts
Medicare Advantage’s 2027 pay raise was set at 2.48%, and insurers are expected to trim extra perks in response.  NewsBreak: Local News & Alerts
CMS finalizes payment updates and coverage changes for IRFs
CMS finalizes payment updates and coverage changes for IRFs  American Hospital Association
Medicare finalizes hospice, rehab and psych pay hikes
Medicare finalizes hospice, rehab and psych pay hikes  Modern Healthcare
Negotiated Part B Drug Effectuation Proposals: Four SDRA Approaches and Key Tradeoffs
Medicare Is Dropping Two Alcohol and Tobacco Measures from Its Quality Program for Psychiatric Hospitals
Medicare Is Dropping Two Alcohol and Tobacco Measures from Its Quality Program for Psychiatric Hospitals  Medical Daily
Indiana plans to cover GLP-1s for some Medicaid members under BALANCE model - beckerspayer.com
Indiana plans to cover GLP-1s for some Medicaid members under BALANCE model  beckerspayer.com
1. CMS finalizes payment rules for inpatient psychiatric, skilled nursing facilities
1. CMS finalizes payment rules for inpatient psychiatric, skilled nursing facilities - Becker's Hospital Review  Becker's Hospital Review