ASM is a five-year, mandatory model that will hold outpatient specialists accountable for their performance on relevant quality, cost, care coordination, and electronic health record use metrics. The model specifically targets heart failure and low back pain. The model maintains fee-for-service payment, but retrospectively evaluates performance on cost and quality metrics, with payment adjustments based on performance outcomes. 

CMS is launching a first-of-its-kind model that puts technology companies at the center of Medicare’s prior authorization process with the Wasteful and Inappropriate Service Reduction (WISeR) Model. The WISeR Model aims to focus health care spending on services that improve patient well-being, apply lessons learned from commercial payer prior authorization processes that may be faster, easier, and more accurate, increase transparency of existing Medicare coverage policy, and de-incentivize and reduce the use of medically unnecessary care.  

The prominence of program integrity discussions at this year's CMS Quality Conference signals a fundamental shift in how this administration is framing health care policy. Alongside the traditional focus areas of prevention, digital transformation, value-based care, and vulnerable populations, the emphasis on eliminating waste has become the connecting thread across all initiatives.

Every year, a few drug policy headlines make the rounds that sound like big wins. And every year, we see stakeholders scramble to respond, only to find that the impact is… a little less transformative than promised. 

In theory, claims data should tell you what was prescribed, what was filled, and how much it cost. In practice, it tells a partial, delayed, and sometimes misleading version of that story. 

Skyrocketing demand, unclear coverage criteria, inconsistent outcomes data, escalating costs, and public frustration. These are symptoms of a system that wasn’t built for drug innovation at this scale or speed. 

As the U.S. population ages rapidly, with 82 million Americans projected to be over 65 by 2050, the demand for long-term services and supports is growing. Yet, the formal caregiving workforce alone can't meet this need. Increasingly, family members and friends are stepping in to serve as informal caregivers to help older adults remain in their homes and communities.

President Trump issued an Executive Order on April 15, 2025 focused on lowering high drug prices for Americans, reinforcing a goal set in his previous administration.

The National Association of ACOs (NAACOS) held its annual spring conference in Baltimore April 22-24. The event brought together NAACOS members, industry thought leaders, and businesses building innovative tools for value-based care and health system transformation.

In value-based care (VBC), pharmacy spend should be visible, actionable, and strategically aligned. Too often, it’s not. It’s carved out, separately contracted, buried in fee-for-service logic, or treated as a black box passed between vendors. Meanwhile, drug therapies are central to chronic condition management, cost avoidance, and patient outcomes. So why the disconnect? 

The idea of the federal government negotiating drug prices isn’t new. What is new is that we’ve crossed a line, from debating whether the government should negotiate to figuring out how it will. That shift opens up a cascade of questions not just for pharmaceutical companies, but also for payers, providers, states, and patients. 

In December 2024, the National Health Statistics Group in CMS published an updated report on U.S. health care expenditures. Health care expenditures in the United States are extraordinarily high, surpassing other OECD countries by nearly 6% of GDP for equivalent or worse health outcomes.