Provider Networks
Expert articles and analysis related to provider networks.
AI Summary — Last 30 Days
CMS is pushing provider networks toward broader mandatory participation and tighter accountability, most notably by expanding required participation in the joint replacement model by 2028—an important signal that episode-based payment will increasingly shape hospital–post-acute network design, home health partnerships, and specialist alignment strategy (Home Health Care News). At the same time, payers and market entrants are building narrower, condition-specific value networks—from Transcarent’s bundled CAR-T/BiTE oncology model across community providers to SCAN’s retail-enabled Costco partnership—while Medicaid is testing drug-cost and obesity-management accountability through the BALANCE model, creating new tensions around access, steerage, pharmacy spend, and who controls the patient relationship (Transcarent model). For ACOs and health systems, the throughline is that network strategy is becoming more actuarial and operational: success depends less on broad affiliation and more on curated referral channels, post-acute performance, specialty-cost management, and the ability to absorb policy-driven shifts in Medicare Advantage, Medicaid, and CMMI payment models under the Trump administration.
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