Policy & Regulatory Changes
Expert articles and analysis related to policy & regulatory changes.
AI Summary — Last 30 Days
CMS’ latest ACO REACH data is sharpening the policy tension around CMMI’s portfolio: the model produced $988 million in Medicare savings in 2024, up from roughly $695 million in 2023, even as it remains scheduled to sunset at year-end—creating strategic uncertainty for high-needs, home-based, hospice, and nursing-facility-oriented organizations that built care models around REACH incentives (Healthcare Dive). At the same time, the Trump administration’s CMS is moving on multiple fronts that signal a harder-edged VBC environment: mandatory bundles such as CJR-X are re-emerging as a core accountability tool, physician payment proposals could reshape ACO–home care economics, and Medicare Advantage Star Ratings litigation underscores growing payer-provider exposure to CMS quality methodology and revenue adjustment risk. For ACOs, health systems, and payer partners, the near-term strategy is to preserve REACH-like capabilities—advanced risk coding governance, post-acute management, home-based care integration, and specialty cost control—while preparing for a more mandatory, more scrutinized CMMI under CMS Administrator Dr. Mehmet Oz and CMMI Director Abe Sutton.
Related Articles
DOJ’s Continued Focus on Medicare and Medicaid Fraud Produces $6.5 Billion Health Care Fraud Takedown
UCHealth Partners with Avant-garde Health to Strengthen Surgical Performance Under CMS TEAM
UCHealth Partners with Avant-garde Health to Strengthen Surgical Performance Under CMS TEAM Business Wire
Healthcare faces congressional oversight heading into 2026 midterms and beyond
Democrats are planning investigations into major healthcare topics if they win majorities in Congress this November. Healthcare firms should prepare for increased oversight now, write lawyers with Hol...
Conquering Medicare's ACCESS program
There was so much excitement when CMS announced the ACCESS program. Finally, a way for digital health companies to make their mark on Medicare! A program that pays only if patients get better! But t...
How digital health companies are planning to conquer CMS ACCESS
A new Medicare experiment to manage seniors’ chronic diseases will pay some digital health companies only about as much in a year as they might earn for a couple of patient visits from commercial insu...
Innovaccer Targets Growth in Medicare Value-Based Chronic Care Through CMS ACCESS Participation
Innovaccer Targets Growth in Medicare Value-Based Chronic Care Through CMS ACCESS Participation TipRanks
CMS ACCESS Model launches in July: What doctors should know - American Medical Association | AMA
CMS ACCESS Model launches in July: What doctors should know American Medical Association | AMA
Toolkit: Analyzing Telehealth Claims to Assess Program Integrity Risks - Office of Inspector General (.gov)
Toolkit: Analyzing Telehealth Claims to Assess Program Integrity Risks Office of Inspector General (.gov)
CMS ACCESS Go Live: Medicare Starts Buying Outcomes
CMS ACCESS Go Live: Medicare Starts Buying Outcomes On July 5, the ACCESS model goes live and Traditional Medicare becomes, for the first time, a purchaser of clinical results rather than clinical act...