Payment Models
Expert articles and analysis related to payment models.
AI Summary — Last 7 Days
Payment-model scrutiny is intensifying across Medicare Advantage, specialty care, home health, and Medicaid financing: CMS is weighing tougher home health enrollment controls tied to the 2027 payment rule while stakeholders are pushing changes to the Ambulatory Specialty Model, and KFF’s analysis of Medicare Advantage coding intensity underscores continued pressure to improve MA risk-adjustment accuracy. At the same time, providers are signaling more willingness to take downside risk—Bayada’s new CEO is positioning home health growth around value-based risk rather than payer contracts alone—while oncology and behavioral health discussions point to continued demand for models that better align specialty care, access, and total-cost accountability. The tension for VBC leaders is clear: federal policy is moving toward tighter payment integrity and model discipline, while provider organizations need enough flexibility and predictable benchmarks to invest in care management, specialty integration, and risk-bearing infrastructure.
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