Medicare Programs
Expert articles and analysis related to medicare programs.
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CMS is accelerating Medicare value-based payment under the Trump administration by expanding condition-based and episode-based models: the ACCESS Model is being broadened for 2027 to include chronic conditions such as COPD, substance use disorder, tobacco cessation, and heart failure, signaling a deeper push into tech-enabled longitudinal chronic care management and population health accountability (Healthcare Dive). At the same time, evidence from CJR and early TEAM implementation points toward continued momentum for mandatory or quasi-mandatory episode payment expansion, with hospitals, post-acute providers, and home health agencies facing stronger incentives to shift care outpatient, tighten discharge coordination, and manage total cost of care across settings (TechTarget). Parallel developments in Medicare Advantage—OIG risk-adjustment audits and star-rating litigation/market reactions—underscore a growing tension between CMS’s push for scalable VBC models and heightened scrutiny of coding accuracy, quality measurement, and payer financial performance.
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