Provider Networks
Expert articles and analysis related to provider networks.
AI Summary — Last 7 Days
Provider-network economics are tightening as the Trump administration advances Medicaid drug-pricing and coverage models while hospitals push back on CMS proposals that would reduce 340B and site-neutral outpatient revenue—pressures that could reshape health system participation in VBC arrangements and narrow the financial cushion supporting population-health infrastructure. Indiana Medicaid’s move to cover GLP-1 obesity drugs through the federal BALANCE model signals growing use of Medicaid purchasing models for high-cost chronic disease therapies, while new White House drug-pricing pacts extend Medicaid-focused affordability strategies beyond major pharma manufacturers. At the same time, ACO performance remains highly uneven but material: Essen Health Care’s Atlas IPA reported the nation’s highest net savings rate among 2024 ACO REACH participants, underscoring how independent physician networks can outperform in risk-based models even as hospital-led networks face mounting payment headwinds from CMS 340B/site-neutral proposals (Indiana BALANCE model; 340B/site-neutral pushback).
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