Current & Emerging Payment Models
The Centers for Medicare & Medicaid Services Dec. 23 introduced a new drug pricing model, BALANCE, for Medicare Part D and Medicaid beneficiaries.
The Centers for Medicare & Medicaid Services announced Dec. 18 that it will launch a voluntary payment model designed to broadly reach more health care providers who have not joined accountable care organizations, including those with specialized patient populations and others such as small,…
The Centers for Medicare & Medicaid Services Innovation Center will launch a new, outcome-aligned payment model for providers offering technology-supported care to individuals with Original Medicare for managing common chronic conditions. The Advancing Chronic Care with Effective, Scalable…
Aetna’s new “level of severity inpatient payment” policy is now set to take effect Jan. 1, 2026, the company recently announced, along with providing additional details about the policy. The policy was supposed to take effect Nov. 15.
The Centers for Medicare & Medicaid Services is launching a new initiative for state Medicaid programs to purchase prescription drugs at prices aligned with those paid in other countries, known as most-favored-nation pricing.
The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and Inappropriate Service Reduction model.
Automating health care insurance claims management with AI-powered tech can speed denials resolution - TrailBlazers
The Centers for Medicare & Medicaid Services has issued the 2025-2026 Medicaid Managed Care Rate Development Guide for states to use when setting managed care capitation rates for the rating periods between July 1, 2025, and June 30, 2026.
The AHA today filed an amicus brief in the U.S. Court of Appeals for the D.C. Circuit, defending the Department of Health and Human Services’ decision to prevent drug companies from implementing a 340B rebate model. The brief was filed in a consolidated appeal involving five drug companies. The AHA…
Payment ModelsCare Delivery Transformation FrameworkOperational Infrastructure