Total Cost of Care
Expert articles and analysis related to total cost of care.
AI Summary — Last 7 Days
Total cost of care strategy is shifting from broad primary-care attribution toward more operationally specific risk levers: health systems are negotiating payer-by-payer downside-risk arrangements based on whether plans can support joint clinical redesign, while specialists, bundled-payment vendors, and chronic-condition episode designers are pushing episode-based accountability deeper into specialty and longitudinal care. At the same time, post-acute and home-based care are becoming central control points for Medicare VBC economics, with LEAD readiness emphasizing post-acute visibility and the Trump administration’s CMS freezing new hospice and home health Medicare enrollment in selected areas—raising compliance and network-capacity questions for ACOs and risk-bearing groups. Medicaid managed care plans are also preparing for 2027 community-engagement requirements, making eligibility churn, member engagement, and risk adjustment a growing TCOC threat alongside provider-facing payment reform (HFMA on payer risk alignment; Healthcare Brew on CMS hospice/home health freeze).
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