Provider Networks
Expert articles and analysis related to provider networks.
AI Summary — Last 7 Days
Provider-network strategy is becoming more central to VBC execution as CMS’s CMMI, under the Trump administration, advances the 10-year ACCESS chronic care model with a first cohort spanning digital health, connected care, AI-native startups, ACO enablement firms, and tech-enabled plans—signaling a push toward scalable, tech-enabled chronic disease management tied to choice, competition, and taxpayer protection under CMMI’s “Make America Healthy Again” vision (ACCESS model overview). At the same time, Medicare Advantage network disruptions are intensifying access and continuity-of-care risks for retirees, while bipartisan scrutiny of MA oversight is rising—creating tension between narrower-network cost control and the provider stability needed for ACOs, plans, and health systems to deliver longitudinal population health outcomes ([MA network shakeups](https://news.google.com/rss/articles/CBMiigFBVV95cUxOWkhSX192VUJZejh5ejRaSE1OQmJfSW0tTmJDSEJCM1ZCMXduLVhxOVNEc25EcWEzR2pwMVE2cjJjdmljQVdXZHNNUlpGM1BiNmlxNmxUWDBQX3pKM3pCXzRLQU00bUItR
Related Articles
Inside CMS’s Drug Pricing Playbook: What it Means for IPAY 2028 and Subsequent Rounds
Inside CMS’s Drug Pricing Playbook: What it Means for IPAY 2028 and Subsequent Rounds Manatt, Phelps & Phillips, LLP
often done through a proprietary algorithm
From newsletter: The LI Daily: PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs want transparency rule on ice, but drug ...
punted on finalizing a policy
From newsletter: The LI Daily: PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs want transparency rule on ice, but drug ...
Are drug prices value-based?
One of the central tensions in pharmaceutical policy is the gap between what a drug is worth and what it actually costs. In theory, a drug’s price should reflect its value — its ability to improve hea...
CMS extends GENEROUS model deadline for pharma and states
The Centers for Medicare and Medicaid Services is extending the application deadline for drug manufacturers to apply to the GENErating cost Reductions fOr U.S. Medicaid Model. CMS said it made the dec...
group purchasing organizations
From newsletter: The LI Daily: PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs want transparency rule on ice, but drug ...
Prime Therapeutics
From newsletter: The LI Daily: PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs want transparency rule on ice, but drug ...
several new requirements on PBMs
From newsletter: The LI Daily: PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs warn Trump’s proposal to disclose drug prices is illegal PBMs want transparency rule on ice, but drug ...
Hospitals, insurers clash on 340B rebate costs
Hospitals and insurers both urged federal regulators to ignore the cost projections of the other side in their comments on a coming redux of a 340B rebate model. The comments came in response to a req...
Does biosimilar entry reduce cost for patients?
Biosimilars aim to be lower cost options for biologic therapies after loss of exclusivity. A key question is whether these cost savings get passed through to patients via lower out-of-pocket costs. A ...