Medicare Policy
Expert articles and analysis related to medicare policy.
AI Summary — Last 30 Days
CMS is signaling a structural pivot in Medicare VBC: strong 2024 ACO REACH performance—$988 million in Medicare savings before the model sunsets—creates pressure for the Trump administration’s CMS, under Dr. Mehmet Oz and CMMI Director Abe Sutton, to preserve or translate key elements into successor ACO models rather than let momentum dissipate (ACO REACH savings). At the same time, proposed Medicare physician payment and MSSP changes would push more clinicians toward accountable care, phase down MIPS-style reporting, and reshape incentives for ACOs, primary care, and home-based care partners—moves that favor organizations with strong risk management, data infrastructure, and longitudinal care capabilities (Medicare physician fee schedule/MSSP proposal
Related Articles
Key Facts About Medicare Spending Trends and Projections from the 2026 Medicare Trustees Report
This brief provides an overview of key trends in Medicare spending and spending growth, as well as the impact of these trends on out-of-pocket costs for Medicare beneficiaries and Medicare program sol...
Medicare funding projections sharpen concerns over access and payment rates
The latest annual report on the state of Medicare funding reflects a conundrum for healthcare industry stakeholders. Medicare spending on healthcare services is on an increasingly difficult fiscal tra...
Medicare Pre-Claim Review Saved $1.2B In Illinois, Had Little Impact Elsewhere
Democrats to propose bill capping out-of-pocket costs for Medicare enrollees
Democrats to propose bill capping out-of-pocket costs for Medicare enrollees Fierce Healthcare
CMS Announces RAPID Coverage Pathway to Speed Medicare Coverage of New Medical Devices
Democrats To Propose Bill Capping Out-of-Pocket Medicare Costs for Enrollees
Some Senate Democrats want to cap the amount beneficiaries in traditional Medicare have to pay toward care, but the move is expected to draw GOP opposition for potentially adding billions to Medicare ...
95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed - open minds
95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed open minds
Brown scholar offers Congress actionable solutions for Medicare Advantage overpayment issues
Brown scholar offers Congress actionable solutions for Medicare Advantage overpayment issues Brown University
Democrats push for more data on Medicare AI prior authorization pilot
The letter to the CMS from Democrats is the latest salvo from lawmakers concerned that WISeR is delaying care to Medicare beneficiaries.
Medicare Advantage organizations are denying some post-acute care at high rates
Medicare Advantage’s prior authorization process is still a “Wild West,” one expert says.