The Accountable Care Prospective Trend (ACPT) in the Medicare Shared Savings Program (MSSP) could cost accountable care clinicians more than $700 million in lost shared savings for care delivered in 2025. These reductions are the result of inaccurate forecasting embedded directly into MSSP benchmarks.
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By Julie Appleby – Subsidies. Love ’em or hate them, they dominated the news during the Affordable Care Act’s sign-up season, and their reduction is now hitting many enrollees in the pocketbook. While lawmakers continue to disagree on a way forward, and the politics of affordability keeps the issue front and center, it would be understandable to…
CMS continues to bring accountable care to more people with Medicare in 2026, expanding the benefits of high-quality, whole-person health care to achieve better health outcomes for millions of older Americans.
By Stephanie Armour – In the run-up to the 2020 election, all 20 Democratic presidential candidates promised voters they’d pursue bold changes to health care, such as a government-run insurance plan or expanding Medicare to cover every American. Fast-forward to the congressional stalemate that has closed the federal government for more than a month.
By Lauren Sausser & Darius Tahir – Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.
CMS proposed changes will expand reach of the Medicare Diabetes Prevention Program (MDPP) to achieve MAHA goals. Deadline to comment is 9/12/2025.
By Mary Griskewicz – At its core, HTI-4 is about making prescribing and medication access more real-time, transparent, and aligned with patient needs. It updates health IT certification criteria in three key areas: electronic prescribing, real-time prescription benefit (RTPB), and electronic prior authorization (ePA).
The calendar year 2026 Medicare Physician Fee Schedule proposed rule would advance primary care management through new quality measures, reduce waste and unnecessary use of skin substitutes, and introduce a new payment model focused on improving care for chronic disease management.
HHS Secretary Kennedy and CMS Administrator Oz press conference on securing industry pledges to fix the broken Prior Authorization System. They met with insurance leaders of nearly 80% of covered Americans.