Payment Models
Expert articles and analysis related to payment models.
AI Summary â Last 30 Days
CMS payment-model activity is concentrating around mandatory episode-based care and ACO risk calibration: hospitals, MedPAC, AHA, Premier, and NAACOS are positioning around the proposed CJR-X expansion and TEAM-related design choices, with core disputes over benchmark methodology, quality measures, risk adjustment, and whether mandatory bundles create achievable savings or simply shift underpayment risk to hospitals. At the same time, ACO stakeholders are preparing for newer models such as LEAD and ACCESS while vendors build actuarial/risk tools for participants, underscoring that VBC strategy is moving from participation decisions to granular financial-risk management under CMMIâs current direction. Parallel scrutiny of Medicare Advantage coding intensity reinforces a broader Trump administration-era payment-accuracy theme: whether in MA, ACOs, or bundled payments, CMS is tightening attention on coding, benchmarks, and model integrity, raising the stakes for documentation, attribution, and downside-risk governance.
Related Articles
CJR-X: How Data-Driven Strategies Support Success
Simplify, Scale, and Succeed in Bundled Payments for TPAs
Simplify, Scale, and Succeed in Bundled Payments for TPAs  Cedar Gate Technologies
Source: Honolulu Civil Beat
From newsletter: Weekly Health Tech Reads 6/14/26 Weekly Health Tech Reads 6/14/26 Musing on Hawai'i's VBC conundrum, 2032 as a healthcare election, Hinge's investor day, Abridge's bid to be a clinica...
CJR-X: How Data-Driven Strategies Support Success
CJR-X: How Data-Driven Strategies Support Success  Forvis Mazars US
AI Is Scaling Healthcare Costs Because the System Was Built That Way
AI is not driving healthcare cost inflation. It is exposing a system that has always been designed to reward it, and making that system more efficient. As long as reimbursement is tied to intensity, e...
COMPREHENSIVE CARE FOR JOINT REPLACEMENT EXPANDED (CJR-X) - National Association of ACOs (NAACOS)
COMPREHENSIVE CARE FOR JOINT REPLACEMENT EXPANDED (CJR-X)Â Â National Association of ACOs (NAACOS)
AHA recommends changes to CMSâ mandatory payment model for joint replacement procedures
AHA recommends changes to CMSâ mandatory payment model for joint replacement procedures  American Hospital Association
Premier Submits Comments on FY 2027 Medicare Inpatient Payment Proposed Rule
Premier urges CMS to address chronic hospital underpayment and offers detailed recommendations on the TEAM and CJR-X models, as well as quality measurement.
AHA Comments on CMS' FY 2027 Proposed Joint Replacement Expanded Model
AHA Comments on CMS' FY 2027 Proposed Joint Replacement Expanded Model  American Hospital Association
Proposed implementation of the Comprehensive Care for Joint Replacement Expanded model - MedPAC (.gov)
Proposed implementation of the Comprehensive Care for Joint Replacement Expanded model  MedPAC (.gov)