Provider Network Models
Expert articles and analysis related to provider network models.
AI Summary — Last 7 Days
CMS is moving on two network-relevant VBC fronts: the ACCESS chronic care model is adding concrete OAP billing rules and 2026–2027 payment/performance targets, signaling tighter operational expectations for scalable chronic-care networks, while the GENEROUS Medicaid drug pricing model now has all states participating, creating a national Medicaid cost-containment framework that could reshape pharmacy strategy inside risk-bearing provider and payer networks. For ACOs, MA plans, and Medicaid managed care organizations, the week’s throughline is that CMS is pairing broader mandatory or near-universal participation with more data- and outcome-linked payment mechanics—raising stakes around attribution, documentation, pharmacy integration, and performance measurement, especially as Medicare quality bonuses face repricing based on data infrastructure rather than care changes (ACCESS payment targets, [
Related Articles
How TrumpRx Brand-Name Drug Prices Compare to Other Countries
TrumpRx prices for brand-name drugs are about as likely to be higher as lower compared to average prices in other wealthy countries, according to an analysis that compares 32 brand-name drugs (without...
Analysis: Prices for Many Brand-Name TrumpRx Drugs Are Cheaper than the Average Price in Other Wealthy Countries, But Are Almost as Likely To Be More Expensive
Consumers who buy brand-name prescription drugs without an available generic or biosimilar at the prices available through the new TrumpRx website are about as likely to pay more as pay less for those...
Florida AG sues PBMs, pharmas over rise in insulin prices
Florida AG sues PBMs, pharmas over rise in insulin prices Fierce Healthcare
The Role of Comparator Selection in Ex-US HTA and International Drug Pricing
Pfizer, Lilly 'most favored nation' deals to give US share of raised foreign prices
The "most favored nation" drug pricing deals that Pfizer and Eli Lilly signed with the Trump administration suggest the companies will give the government a share of increased revenue they generate fr...
Hospitals are scrambling to keep 340B discounts. Here’s what to know
Hospitals are scrambling to keep 340B discounts. Here’s what to know Modern Healthcare News
FAQ: How the GENEROUS Model Applies MFN Pricing to Medicaid
Report: High Drug Costs Are Creating Hidden Burden for Physicians
Report: High Drug Costs Are Creating Hidden Burden for Physicians MedCity News
Millions of Americans could lose access to cheap Canadian prescriptions next month: 3 notes
Millions of Americans could lose access to cheap Canadian prescriptions next month: 3 notes Becker's Hospital Review
Millions of Americans could lose access to cheap Canadian prescriptions next month: 3 notes
Millions of Americans could lose access to cheap Canadian prescriptions next month: 3 notes Becker's Hospital Review