Payment Models
Expert articles and analysis related to payment models.
AI Summary — Last 24 Hours
CMS payment-model activity is tightening around risk adjustment, specialty care, and post-acute spending: Medicare Advantage coding intensity remains under scrutiny as CMS pursues payment-accuracy changes, while cardiology stakeholders are pressing for modifications to the upcoming Ambulatory Specialty Model to avoid misaligned incentives for specialists and patients (KFF on MA coding intensity). In home health, CMS’ proposed 2027 rule pairs a 2.4% Medicare payment increase with tougher enrollment/fraud controls, creating a mixed signal for providers weighing deeper value-based risk arrangements—especially as organizations like Bayada look beyond payer contracts toward risk-based scaling (home health payment proposal). Medicaid budget pressure is also surfacing, with Oklahoma planning provider cuts, reinforcing the near-term tension between fiscal restraint and the infrastructure needed for population health management.
Related Articles
Decoding Medicare Advantage Coding Intensity
Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS,...
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Heart of Health Policy | ACC Urges Changes as Ambulatory Specialty Model Approaches  American College of Cardiology
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ACCESS Model: behavioral health edition  Fierce Healthcare
[Updated] CMS Proposes 2.4% Home Health Medicare Payment Increase For 2027
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Health Outcomes of Socially Vulnerable Populations in Different Medicare Payment Arrangements  America's Physician Groups
Beyond Payer Contracts: How Bayada’s New CEO Plans To Scale Through Value-Based Risk
Beyond Payer Contracts: How Bayada’s New CEO Plans To Scale Through Value-Based Risk  Home Health Care News
CMS mulls tougher Medicare enrollment rules to combat fraud as part of 2027 home health payment rule
CMS mulls tougher Medicare enrollment rules to combat fraud as part of 2027 home health payment rule  Fierce Healthcare
Why Physicians Belong in the Mid-Revenue Cycle
Why Physicians Belong in the Mid-Revenue Cycle  Becker's Hospital Review