Provider Network Models
Expert articles and analysis related to provider network models.
AI Summary — Last 30 Days
CMS is moving provider-network VBC from voluntary participation toward broader default accountability: the proposed 2027 Medicare Physician Fee Schedule would shift physician payment away from MIPS and toward expanded ACO participation, while CMS is also requiring broader participation in the expanded joint replacement model by 2028—signaling that specialists, hospitals, post-acute providers, and primary care networks will need tighter episode-management and referral infrastructure. At the same time, CMS-reported 2024 ACO REACH performance—nearly $1B in savings—gives ACO advocates and policymakers evidence to defend and expand risk-based models, even as stakeholders debate benchmarking, equity, and provider readiness for mandatory participation. For health systems and payers, the strategic priority is becoming network architecture: aligning primary care, specialty episodes, home health/post-acute capacity, and actuarial risk management before CMS’s next wave of accountability models scales up ([ACO REACH savings](https://news.google.com/rss/articles/CBMipgFBVV95cUxNLUJlTUdtQmRHNWtxdks5VEhyaTdDdnVSQ0JIc2IwaUs0ZFBHTWJFTHd6LVJBM1dYYzNJdGVNbzZ4VWZnNkJpUkJOYTcwenBUZzgzRjFLaE05NHdyb3E3em9iT2E1U0o3NG1jLW56
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