How ACO Conveners Are Changing the Medicare Shared Savings Program (MSSP) Behind the Scenes
The episode examines a new Health Affairs study on third‑party conveners reshaping Medicare’s Shared Savings Program (MSSP). Researchers tracked ACOs from 2012‑2021, finding conveners expanded from 11% to roughly 23% of program beneficiaries and increasingly linked clinicians across distant states. Key findings show geographically dispersed convenor‑run ACOs rose from 9% to 45% of beneficiaries, while locally‑focused ACOs dwindled to 4%. These dispersed networks captured the highest shared‑savings bonuses—about $171 per beneficiary annually—far outpacing local convenor ACOs ($95) and non‑convenor groups. Despite higher earnings, their quality scores matched those of traditional ACOs. Dr. Adam Marovitz highlighted that original ACO concepts envisioned local, integrated physician‑hospital networks, not national aggregators. He cited tools like Milleman’s “ACO Builder,” which map low‑cost physicians for network assembly, suggesting strategic cherry‑picking. The study also noted that dispersed convenors’ patients spent roughly $400 less than regional benchmarks, reinforcing the selection hypothesis. The findings raise policy concerns: conveners may be gaming benchmarks rather than improving care, undermining the MSSP’s intent to align incentives with clinicians. Regulators may need tighter transparency and oversight to ensure ACOs reflect genuine clinical integration rather than cost arbitrage, preserving the program’s cost‑containment goals.
Behind the Drug Discounts: 340B, Medicare Negotiation, and Transparency
The webinar examined how the Inflation Reduction Act’s Medicare drug‑price negotiation program—delivering Maximum Fair Prices (MFPs) for ten high‑spend Part D drugs—intersects with the longstanding 340B discount system. Panelists explained the operational pipeline: claims adjudicated by plans, rebates routed through a...
Why Medicare’s Hospital Wage Index Exceptions Jumped 60%
The podcast examines a striking rise in Medicare’s hospital wage‑index exceptions – a 60% jump between fiscal years 2016 and 2024. The wage index, designed to equalize Medicare payments for regional labor‑cost differences, has become increasingly complex as a suite...
Medicaid Work Requirements: Who’s Affected and What’s at Stake
The Health Affairs podcast aired June 8 2026 discusses the federal “One Big Beautiful Bill Act” (HR 1), which imposes Medicaid work‑reporting requirements and represents the largest ever reduction in federal Medicaid funding—about $1 trillion, a third of which is tied to the new work rules. The rule...
Private Equity in Primary Care: Costs, Care, and Impact
The Health Affairs podcast discusses a new study by Dr. Yasha Sweeney Singh examining private‑equity (PE) acquisitions of primary‑care practices from 2016 to 2022. The research identifies roughly 225 PE deals, representing about 2% of U.S. primary‑care sites overall, but...
Big Changes to Drug Prior Authorization? CMS Proposal Explained
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to overhaul prior authorization (PA) for prescription drugs, mandating electronic submissions across all Medicare Advantage, Medicaid, CHIP, and ACA plans starting October 2027. The rule builds on...
Provider Prices in the Commercial Sector: Reaching a Common Understanding / Hospital Prices
The video opens with Max Seltzer, health‑policy director for Sen. Roger Marshall, highlighting that hospital services represent the single largest share of national health expenditures—about 31%—far exceeding the 9% share of prescription drugs. He notes that private insurance premiums jumped...
Inside CVS Caremark: The Role of PBMs in Drug Costs & Access | SPONSORED
The sponsored Health Affairs podcast features CVS Caremark’s Chief Growth Officer James Marota discussing the evolving role of pharmacy benefit managers (PBMs) in controlling prescription drug costs and improving member access. Marota frames the PBM function around a three‑pillar cost...
Will the Medicare ACCESS Model Spark the Next Health Tech Gold Rush?
The Health Affairs podcast introduces Medicare’s new ACCESS model, launching in July 2026. ACCESS—Advancing Chronic Care with Effective Scalable Solutions—will allow Medicare beneficiaries and their physicians to claim reimbursement for digital health products such as mobile disease‑management apps and wearable...
Policy Changes Reshaping Family Caregiving
The podcast episode examines how recent policy shifts are reshaping family caregiving in the United States. Host Katherine Ornstein and expert Allison Baroff discuss the growing reliance on unpaid family caregivers, the $1 trillion annual economic burden, and the absence of...
Why Teens Are Turning to AI for Mental Health | Caroline Figueroa
The Health Affairs episode spotlights a growing crisis: teens are turning to AI chatbots for mental‑health support despite the tools not being designed for clinical use. Dr. Caroline Figueroa, a Stanford psychiatrist, cites tragic cases where AI interactions preceded suicides,...
Abortion Access In The High Court, Again | Katie Keith
The podcast focuses on a fresh legal battle over the FDA’s 2023 decision to allow mifepristone – the drug used for medication abortions – to be prescribed via telehealth and dispensed at pharmacies. Louisiana’s attorney general, joined by a private...
The ACCESS Model: Health Tech’s Next Gold Rush?
The video outlines a forthcoming Medicare Access Program that will allow beneficiaries and their physicians to obtain FDA‑cleared health apps and wearable devices with federal reimbursement. Unlike today’s corporate‑benefits model, providers will face a senior population with lower digital health literacy,...
When Screening Guidelines Shift: Impacts on Healthcare Access & Use
The podcast examines how recent revisions to screening and treatment guidelines—particularly the ACC/AHA lipid recommendations, newer hypertension targets, and lowered colon‑cancer screening age—reshape health‑care utilization and spending. The lipid update introduces the Prevent risk equations, lowers the treatment threshold to a...
Policy Changes Reshaping Family Caregiving | Age-Friendly Health Series
The Age‑Friendly Health Series podcast examined the rapidly evolving policy environment surrounding family caregiving, featuring host Katherine Ornstein and caregiving scholar Allison Baroff. Baroff highlighted that roughly one‑quarter of Americans serve as unpaid caregivers, a role that now costs the...