Value-Based Purchasing
Expert articles and analysis related to value-based purchasing.
AI Summary â Last 30 Days
Medicare Advantage quality-based purchasing is entering a more contested phase: CMS recalculated Star Ratings after the Clover litigation, and Elevance is now suing over a methodology it says cost the insurer $115 million, underscoring how MA quality scores have become high-stakes revenue assets rather than just performance signals. At the same time, KFF estimates Medicare will spend at least $13 billion on MA Quality Bonus Payments in 2026 even as the share of enrollees in bonus-eligible plans declines, sharpening payer and policymaker scrutiny of whether Stars bonuses are delivering commensurate value. For ACOs, MA plans, and provider groups, the strategic signal is that value-based purchasing is moving toward tighter auditability, legal challenge, and ROI pressureâwhile CMMIâs ACCESS launch narrative points to continued federal interest in tying Traditional Medicare payment more directly to measurable outcomes.
Related Articles
Policy Transmittal 2026-07: Value-Based Purchasing (VBP) Arrangements & Behavioral Analysis Services - open minds
Policy Transmittal 2026-07: Value-Based Purchasing (VBP) Arrangements & Behavioral Analysis Services  open minds
Avoiding Payment Penalties and Maximizing Reimbursement: The Revenue Strategy Health Systems Canât Afford to Miss
Hospitals are under growing pressure as payment programs shift toward value-based models that leave less room for error. The organizations that stand to benefit most are those that recognize a broader...
FQHC CMS-CMMI VBP Opportunities Table
FQHC CMS-CMMI VBP Opportunities Table  NACHC
Preparing For Value-Based Payments: - open minds
Preparing For Value-Based Payments:Â Â open minds
Medicare Advantage plans set to rake in $13B in 2026 quality bonus payments
Medicare Advantage plans set to rake in $13B in 2026 quality bonus payments  Fierce Healthcare
CMS Elicits Tempered Payment Optimism, Stokes Fraud Fears With Proposed Medicare Rule
CMS proposes updates to home health payments for CY 2027, updates to provider enrollment and quality and value-based purchasing programs | AHA News
CMS proposes updates to home health payments for CY 2027, updates to provider enrollment and quality and value-based purchasing programs | AHA News  American Hospital Association
KFF issue brief
From newsletter: Spending on Medicare Advantage Quality Bonus Program Will Total $13.4 billion in 2026 Federal Spending on the Medicare Advantage Quality Bonus Program Will Total $13.4 billion in 20...
CMS ACCESS Go Live: Medicare Starts Buying Outcomes
CMS ACCESS Go Live: Medicare Starts Buying Outcomes On July 5, the ACCESS model goes live and Traditional Medicare becomes, for the first time, a purchaser of clinical results rather than clinical act...
Medicare Will Spend More Than $13 Billion on the Medicare Advantage Quality Bonus Program in 2026
The Medicare program will spend at least $13 billion on the Medicare Advantage quality bonus program in 2026, as 68% of Medicare Advantage enrollees are in a plan that qualifies for higher payments un...