Health Care Matters | June 27, 2025
News You Can Use: HCTTF Names Theresa Dreyer as CEO
The Health Care Transformation Task Force has named Theresa Dreyer as their new Chief Executive Officer, promoting her from the interim role she's held since October 2024. With over a decade of experience in value-based care, she'll officially take the helm on July 1st to continue driving policies that help patients access quality health care at affordable prices. Congratulations, Theresa!
Health Insurers Announce Prior Authorization Reforms Amid Doubts Over Voluntary Compliance
The NY Times, Washington Post, the Hill, and Modern Healthcare report that major health insurers covering 260 million Americans have committed to substantially reforming their prior authorization practices over the next 18 months, responding to escalating pressure from lawmakers, regulators, and public criticism. The agreement, announced by AHIP and the Blue Cross Blue Shield Association alongside 48 companies including UnitedHealthcare, Aetna, and Cigna, establishes goals to streamline approval processes by resolving 80% of requests in real-time by 2027, narrow the scope of procedures requiring prior authorization, standardize electronic request systems, and enhance communication regarding denials.
The industry has enacted similar voluntary commitments previously, particularly in 2018, with disappointing results prompting consumer advocates to demand statutory requirements rather than voluntary guidelines. Federal officials, including HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, have endorsed the initiative and promised accountability through establishing a public dashboard to monitor compliance, though the voluntary nature of these commitments raises questions about enforceability. Read more here, here, here, and here.
Why It Matters
Evaluation by financial analysts posit that these changes will produce minimal impact on insurers' profit margins and suggest the reforms may constitute more public relations than substantive change. Expectations warrant caution as the genuine test will be whether the promised accountability measures and regulatory oversight can ensure insurers execute their commitments this time. Republican lawmakers like Senator Roger Marshall and Representative Greg Murphy, both physicians, remain committed to codifying these reforms through legislation rather than relying solely on voluntary agreements. If the reforms prove superficial, as previous efforts have demonstrated, it could amplify calls for congressional action and stricter regulatory requirements, potentially creating more disruptive changes for the insurance industry in subsequent years.
New ACA Rules Could Strip Health Care from Nearly 2 Million Americans
The Trump administration has finalized sweeping changes to the Affordable Care Act (ACA) marketplace through new rules that will significantly restrict enrollment and reduce subsidies. The changes, announced June 20, 2025, include shortening the annual open enrollment period, eliminating monthly special enrollment for low-income consumers, requiring $5 monthly premiums for automatically re-enrolled consumers with zero-premium plans, and barring DACA recipients from purchasing marketplace insurance. HHS projects these changes will cause 725,000 to 1.8 million people to lose coverage in 2026 alone, while claiming the rules will reduce premiums by about 5% and save taxpayers $12 billion annually by combating "improper enrollments". Notably, many of the most restrictive provisions will sunset after 2026, which experts believe is designed to maximize budget savings claims for Congressional Republicans' reconciliation legislation. Read more here and here.
Why It Matters
These changes represent the most significant rollback of ACA protections since the law's inception and will likely increase the uninsured rate substantially. The shortened enrollment periods and new verification requirements will create barriers for vulnerable populations, including those with limited English proficiency, rural residents, and low-income families who may struggle to navigate the more complex system. The elimination of DACA recipient eligibility alone affects hundreds of thousands of young adults, while the $5 premium requirement for auto-enrolled consumers could cause confusion and coverage losses among the most vulnerable. The timing suggests these temporary restrictions are part of a broader Republican strategy to permanently codify even harsher restrictions through budget reconciliation, potentially leading to millions more losing coverage if Congress acts on pending legislation that would eliminate automatic re-enrollment entirely and impose stricter verification requirements.
Value-Based State-Directed Payments in Medicaid Managed Care
A new analysis in JAMA Health Forum reveals that although states have directed more than $144 billion in Medicaid managed care spending through state-directed payments (SDPs) between February 2023 and May 2024, only about 5% of those funds were tied to value-based payment models. Among the 77 approved value-based SDP programs, the overwhelming majority focused on basic pay-for-performance or reporting incentives, with very few advancing into shared savings or population-based payment models. Most of the funding flowed to hospitals, with much smaller portions reaching primary care, behavioral health, nursing homes, or Medicaid ACOs. Notably, fewer than half of eligible states have used SDPs to promote value-based care at all, and only a small subset have explored more advanced payment arrangements. This suggests that while SDPs offer a potentially powerful tool to align Medicaid spending with value, the bulk of activity remains in early-stage, low-accountability models.
Why It Matters
For those committed to value-based care and alternative payment reform, the findings are both a wake-up call and a call to action. Despite having access to flexible financial tools through SDPs, most states have stopped short of using them to catalyze deeper payment reform. This is particularly important as federal scrutiny of SDPs intensifies and Medicaid faces looming fiscal constraints. States relying heavily on pay-for-performance models may find themselves exposed if policy changes demand more rigorous, outcomes-based approaches that drive cost savings. The data underscores the urgent need to shift from performance-light models toward those that embed shared accountability, better support primary and behavioral care, and deliver more equitable outcomes across the system while controlling costs.
Look for the Helpers: Centering Lived Experience: Yale Team Transforms Care for Incarcerated Patients
The DEPART initiative at Yale New Haven Health System represents a groundbreaking approach to health care equity by directly connecting community members with lived experience of incarceration to medical students and health care providers through experiential learning events. Led by Dr. Carmen Black and her interdisciplinary team, this program developed a comprehensive clinical care pathway and bill of rights for incarcerated patients, while creating a culturally authentic learning environment that increased student comfort levels in treating this vulnerable population from 34-36% to 62-74%. Their work demonstrates how centering community expertise and lived experience can transform both medical education and clinical practice to better serve marginalized patients with dignity and humanity. Read here.
What We Are Reading
Advancing State-Based Health Reform through the NC State Transformation Collaborative: A Multistakeholder Initiative in Action
A new issue brief from the Milbank Memorial Fund describes how North Carolina's State Transformation Collaborative is using a multistakeholder alignment framework to advance value-based care by engaging critical stakeholders, establishing shared goals, building consensus for collective action, and implementing pilot programs that address specific barriers to provider participation in value-based payment models. Read here.
Job Opportunities
Vice President of Population Health
JPMorgan Chase's Morgan Health team is seeking a Vice President of Population Health to lead strategic quality improvement initiatives in employer-sponsored insurance, requiring 7+ years of experience in quality measurement or population health with opportunities to drive innovation through data analysis, stakeholder engagement, and public thought leadership. To learn more, click here.
Pop Health Podcast
Unpacking CMS Reforms to ACO REACH for 2026
CMS rolled out major updates to the ACO REACH Model for Performance Year 2026, with new policies affecting benchmarks, risk scores, and quality incentives, we break down what’s changing with Coral’s own Maria Alexander and Joy Chen along with guest expert Noah Champagne from Milliman.