Total Cost Management
Expert articles and analysis related to total cost management.
AI Summary — Last 24 Hours
CMS and the Trump administration are tightening federal leverage over total cost management: Dr. Mehmet Oz’s CMS is using clawback authority and state plan approvals to steer the $50B Rural Health Transformation Program, while a new CMS rule is forcing states to rework Medicaid work-requirement strategies—raising operational and coverage-risk questions for ACOs, rural systems, and Medicaid managed care partners. At the same time, health systems are negotiating uneven payer appetite for downside risk, with some plans offering clinical collaboration to reduce low-value and avoidable care while Medicare Advantage, Medicaid payment pressure, prior authorization, and MA utilization disputes remain central friction points for VBC execution (HFMA on payer risk; KFF on rural fund controls).
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