Provider Network Models
Expert articles and analysis related to provider network models.
AI Summary — Last 7 Days
CMS is continuing to push provider networks toward mandatory, episode-based accountability, with expanded joint replacement model participation expected by 2028—raising the stakes for hospitals, ASCs, home health agencies, and post-acute partners to manage total cost, discharge pathways, and functional outcomes across orthopedic episodes (Home Health Care News). At the same time, the proposed 2027 OPPS/ASC payment update—2.4% before future offsets—signals tighter facility economics that could accelerate site-of-care shifts and make network design more contentious for ACOs and payers balancing access, leakage, and preferred-provider performance (HFMA). In Medicaid, Indiana’s planned GLP-1 coverage under the BALANCE model shows states testing targeted population-health investments within budget constraints, while CMS’s drug prior authorization proposals and MA fraud enforcement underscore a broader push to align utilization management, affordability, and program integrity across risk-bearing networks.
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The Health Resources and Services Administration (HRSA) followed through with plans to pilot a rebate model for the 340B Drug Pricing Program beginning Jan. 1, 2027. As described in a notice published...
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The government is forcing PBMs to be more transparent, but will reforms make a difference?
The Consolidated Appropriations Act, passed in February, included several significant reforms for PBMs.
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Momentous change may be looming for the 340B Drug Pricing Program, currently managed by the Health Resources & Services Administration (HRSA). An ongoing debate regarding the program’s effectiveness r...
STAT+: Trump administration revises rebate pilot for 340B drug discount program, angering hospitals
The Trump administration is revising its rebate pilot for the 340B drug discount program, angering hospitals.