Medicare Payment & Programs
Expert articles and analysis related to medicare payment & programs.
AI Summary — Last 30 Days
CMS, under the Trump administration, is accelerating a structural shift toward mandatory value-based payment and population-level risk in Medicare, with the proposed nationwide “CJR-X” bundled payment model expanding episode-based accountability for joint replacements to most hospitals by 2027 and emphasizing tighter hospital–home health coordination [source]. In parallel, the LEAD (Long-term Enhanced ACO Design) Model signals CMS’s intent to lock in historical benchmarks, expand capitated payments, and deepen specialist risk-sharing for ACOs from 2027–2036—foreshadowing a more prescriptive, scaled approach to accountable care, with substantial implications for provider risk appetite, health system strategy, and downstream care delivery transformation [source]. These moves collectively reflect a transition from voluntary, incremental models to enforced, systemwide value orientation, intensifying pressure on stakeholders to adapt to more comprehensive risk and integration requirements.
Related Articles
War and Medicare Enrollment
Combat is often described as hours of boredom intermixed with moments of sheer terror. I fear that that metaphor is increasingly applicable to Medicare enrollment. Few things in life are more boring ...
CommonSpirit Medicare Advantage Deal Could Be A Game Changer For Humana (HUM) - simplywall.st
CommonSpirit Medicare Advantage Deal Could Be A Game Changer For Humana (HUM) simplywall.st
CMS considering automatic enrollment in a Medicare Advantage plan
CMS considering automatic enrollment in a Medicare Advantage plan Healthcare Finance News
The Medicare Advantage paradox: Who benefits most?
The Medicare Advantage paradox: Who benefits most? Becker's Hospital Review
Medicare Advantage Linked to Higher Hospice Use in Advanced Cancer Patients
CMS considering automatic enrollment in a Medicare Advantage plan
The Centers for Medicare & Medicaid Services is considering a policy to automatically enroll seniors in a Medicare Advantage plan, according to STAT.
CommonSpirit, Humana reach new nationwide Medicare Advantage contract
The new agreement will give Humana’s MA members access to CommonSpirit’s doctors and facilities for the next three years, and returns CommonSpirit to Humana’s networks in Colorado and Texas.
MA Enrollment, the SNP Acceleration, and What They Mean for Providers Taking MA Risk
Special Needs Plan (SNP) enrollment grew 23% in two years. If you’re in a Medicare Advantage (MA) risk arrangement, that’s not a trend to monitor; it’s a contract assumption to revisit. Over 8.2 mill...
What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid
This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demo...
new KFF analysis
From newsletter: The Proposed BALANCE Model Would Expand Access to and Lower Costs of GLP-1 Drugs in Medicare and Medicaid The Proposed BALANCE Model Would Expand Access to and Lower Costs of GLP-1 ...