Medicare Payment Policy
Expert articles and analysis related to medicare payment policy.
AI Summary — Last 30 Days
CMS under the Trump administration is accelerating Medicare payment-model activity around specialty episodes, chronic disease management, and drug spending: CJR savings are being used to justify broader bundled-payment expansion, TEAM is pushing hospitals toward tighter post-acute and home health coordination, and CMS is expanding the ACCESS Model to additional chronic conditions such as COPD, substance use disorder, tobacco cessation, and heart failure beginning in 2027. For ACOs, health systems, and MA-aligned providers, the strategic signal is a continued shift from voluntary, narrow VBC pilots toward scalable models that combine downside-risk readiness, outpatient substitution, digital chronic-care infrastructure, and tighter coding/compliance oversight—reinforced by OIG audits of Medicare Advantage diagnosis submissions. At the same time, CMS’s finalized GLOBE drug payment model adds a parallel pressure point on pharmaceutical spending, making drug-cost management and specialty-care integration increasingly central to VBC economics (ACCESS expansion; CJR savings and expansion).
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