The LEAD Model-Kidney Care’s Value-Based Care Journey LEADs Here - CMS’s LEAD Model marks the next evolution in valuebased kidney care, integrating CKD and ESRD patients into a primary care-centered ACO framework. As CKCC...more
Following our original publication on April 23, 2026, we have had numerous conversations with stakeholders, nephrology practices, industry associations and the Center for Medicare and Medicaid Innovation (“Innovation...more
Providers caring for patients with chronic conditions have for years faced a persistent mismatch between how care is delivered and how Medicare pays for it. Managing chronic illness often requires ongoing monitoring,...more
Key Takeaways: CMS’ Innovation Center is accelerating new payment and care delivery models as the Trump administration uses CMMI to advance health policy priorities....more
On April 10, 2026, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2027 Inpatient Prospective Payment System (IPPS) proposed rule – the major annual rule impacting Medicare inpatient payments....more
Following the Trump administration’s recent release of its FY 2027 budget request, cabinet secretaries and other administration officials began to make the rounds on Capitol Hill this week, testifying before committees of...more
In this episode, Gabriel Scott, Kevin Alonso, and Kennedy Caldwell break down the new Long Term Enhanced ACO Design (LEAD) Model and its impact on accountable care. They provide background on the model, outline key new...more
On April 1, 2026, the Centers for Medicare & Medicaid Services (CMS), through the CMS Innovation Center (CMMI), officially launched a new pilot program which allows participants in specific CMS programs to offer eligible hemp...more
As specialty care providers prepare for fundamental payment and reporting changes brought by the new Centers for Medicare & Medicaid Services (CMS) Ambulatory Specialty Model (ASM), lenders in the healthcare industry should...more
The Centers for Medicare & Medicaid Services’ ("CMS") Advancing Chronic Care with Effective, Scalable Solutions ("ACCESS") Model is a Center for Medicare and Medicaid Innovation ("CMMI") initiative testing outcome-aligned...more
On March 31, the Centers for Medicare & Medicaid Services (CMS) Innovation Center released the much anticipated Request for Applications (RFA) for the Long‑term Enhanced Accountable Care Organization Design (LEAD) Model, a...more
The Center for Medicare & Medicaid Services Innovation ("CMMI") announced the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-Based Approaches Through Evidence ("MAHA ELEVATE") Model, designed to improve...more
The Center for Medicare and Medicaid Innovation (CMMI) recently released information about three new models aimed at testing alternative calculations for manufacturer rebates, to ensure net drug prices are closer to those in...more
J.P. Morgan continues to surprise us at lunch, with the Mayor of San Francisco sharing on Monday an update on recent improvements in the city. Then on Tuesday at the Grand Ballroom lunch, it was the first episode of my...more
The Trump administration has announced a pricing initiative designed to reduce the cost of glucagon-like peptide-1 (GLP-1) drug products for certain Medicare enrollees....more
The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value‑Based Approaches Through Evidence (“MAHA ELEVATE”) Model is a new federal initiative focused on expanding access to preventive and lifestyle-based care...more
The Center for Medicare and Medicaid Innovation (CMMI) recently announced a voluntary, 10-year Medicare payment and service delivery model: Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model....more
On December 19, 2025, the Centers for Medicare & Medicaid Services (“CMS”) proposed two mandatory Center for Medicare and Medicaid Innovation (“CMMI”) drug payment models to test whether alternative methods for calculating...more
On December 11, 2025, CMS issued a proposed rule to update and revise the Increasing Organ Transplant Access (IOTA) Model for Performance Year (PY) 2 (the Proposed Rule). The IOTA Model is a 6-year mandatory alternative...more
During the Nelson Mullins 2025 Annual Value-Based Care Forum, Navigating Opportunities in a Value-Driven World, virtual attendees submitted questions for the panelists to answer. Below are the panelists’ responses, which...more
Our Drug Pricing and Market Access team tracks recent developments in healthcare reform, the Medicaid Drug Rebate Program, the 340B Program, Medicare, and state law....more
On December 18, 2025, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Long-term Enhanced ACO Design (LEAD) Model, a voluntary accountable care organization (ACO) initiative set to launch...more
A new Food and Drug Administration ("FDA") pilot opens the door for digital health devices without FDA premarket authorization to be used to provide care paid under the Center for Medicare and Medicaid Innovation ("CMMI")...more
On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule, which finalized the Ambulatory Specialty Model (ASM), targeting...more
The Centers for Medicare & Medicaid Services (CMS) has announced that the Center for Medicare and Medicaid Innovation (CMMI) is testing an outcome-aligned payment (OAP) approach designed to give Medicare fee-for-service (FFS)...more