Current & Emerging Payment Models
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
Representatives from CMMI discuss AHEAD Model updates, including version 3.0 financial specifications, and answer questions from members. If AHA members have questions, please submit to VBP@aha.org . View recording and download slides.
The AHA March 27 made a series of recommendations to the Physician‐Focused Payment Model Technical Advisory Committee to address barriers to participating in population-based total cost-of-care and primary and specialty care models.
The Centers for Medicare and Medicaid Services Innovation Center (CMMI) issued guidance yesterday to update timelines for certain alternative payment models. The agency will shorten timelines for four models and will no longer pursue two additional models that were previously announced. CMMI…