Total Cost of Care
Expert articles and analysis related to total cost of care.
AI Summary — Last 30 Days
Total-cost-of-care strategy is shifting from broad primary-care attribution toward more granular specialty and episode economics: CMMI’s CJR-X and LEAD-oriented activity, chronic-condition episode design, GI specialty integration, and post-acute visibility all point to a next phase in which hospitals, specialists, and post-acute networks are expected to manage avoidable utilization inside tighter bundled or longitudinal accountability structures. At the same time, payer-provider risk contracting remains uneven—some plans are co-managing low-value care reduction while others are more cautious on downside risk—making actuarial alignment, data sharing, and clinical operating partnership decisive capabilities for health systems pursuing VBC contracts. Medicare Advantage remains a dominant but contested TCOC platform, with 55% of eligible beneficiaries enrolled in MA in 2026 even as OIG scrutiny of high prior-authorization denial rates for LTACH and inpatient rehab underscores the tension between utilization control, access, and site-of-care management (KFF MA trends; HFMA payer-risk contracting).
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