Health Care Matters | September 25
BPCI Advanced Generates More Than $800 Million in Medicare Savings
The Centers for Medicare & Medicaid Services (CMS) released the final evaluation of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which generated more than $800 million in net Medicare savings across eight model years. Participating hospitals and physician group practices reduced spending by an estimated $700 to $1,100 per episode, while CMS found that the model also increased attention to post-acute care costs, discharge decisions, and patient recovery. Although BPCI Advanced did not meet the Innovation Center’s criteria for formal expansion, CMS is carrying forward lessons from the model into the mandatory Transforming Episode Accountability Model (TEAM), which began in January 2026. Read here.
Why It Matters
BPCI Advanced adds to the evidence that episode-based payment can reduce Medicare spending when providers are accountable for the cost and quality of care across an entire episode, rather than only for individual services. The findings are especially relevant as CMS shifts from voluntary bundled payment models toward mandatory participation through TEAM. BPCI Advanced also shows that the value of episode-based payment extends beyond the savings calculation itself: participants changed how they evaluated post-acute care and discharge patterns, suggesting that financial accountability can influence care delivery decisions across settings. The challenge for future models will be preserving those incentives while designing benchmarks and participation requirements that work across a much broader range of hospitals and markets.
CMS Seeks Input on New Medicare Part D Pharmacy Contracting Standards
CMS is seeking public input as it develops new standards for what constitutes “reasonable and relevant” pharmacy contract terms under Medicare Part D. Beginning in 2029, Part D plans will be required to allow any pharmacy that meets their standard contract terms to participate in the plan’s network, with those terms subject to standards established by the Department of Health and Human Services. CMS is asking for feedback on pharmacy reimbursement and dispensing fees, specialty pharmacy networks, preferred and non-preferred network arrangements, vertical integration among plans, pharmacy benefit managers, and pharmacies, and whether current contracting practices contribute to pharmacy closures or limited access in rural and underserved communities. Comments are due November 23, 2026. Read here.
Why It Matters
The RFI could lay the groundwork for significant changes in how Part D plans and pharmacies negotiate network participation and reimbursement. CMS is looking beyond whether a pharmacy technically has an opportunity to join a network and asking whether payment rates, specialty designations, contracting practices, and vertically integrated arrangements make that participation financially viable in practice. That distinction could be particularly important for independent and rural pharmacies operating on thin margins. The eventual standards will need to balance broader pharmacy access and competition with plans’ ability to manage networks and drug spending, making the rulemaking that follows this RFI consequential for pharmacies, Part D sponsors, pharmacy benefit managers, and beneficiaries alike.
Look for the Helpers: Bringing Care Directly to Patients When Access Breaks Down
Children’s Healthcare of Atlanta is partnering with Emory and Morehouse schools of medicine to train pediatric residents at a new clinic in Atlanta’s Adamsville community. About 65 residents will rotate through the site each year, gaining experience caring for children with a range of needs while helping expand access in a state where more than 60 counties have no practicing pediatrician. The effort connects workforce training directly to community need, giving future physicians experience in the places where their work can have an immediate impact. Read more here.
What We Are Reading
The Medicare Cost Curve: Understanding the Role of Value-Based Care
A Forbes Business Council article examines how value-based care could help address rising Medicare spending by shifting incentives toward prevention, coordination, and outcomes rather than service volume. Read here.
Defining Home- and Community-Based Services
A Health Affairs Forefront article proposes a shared definition of home- and community-based services to support clearer policy, measurement, and accountability across programs serving older adults and people with disabilities. Read here.
Medical Societies Join Lawsuit Against Medicaid Work Requirements
Modern Healthcare reports on a lawsuit brought by physician groups, Medicaid enrollees, and the city of Columbus challenging CMS rules on Medicaid work requirements, including the agency’s narrower medical frailty standard, limits on self-attestation, and substance use disorder exemption criteria. Read here.
UnitedHealth, CVS Push Back on Medicare Plan to Curb Remote Patient Monitoring
STAT reports on insurer opposition to a CMS proposal that would require remote patient monitoring services to be delivered by direct employees of the billing practice rather than outside vendors. Read here.
Pop Health Podcast
Making Collaboration a Core Population Health Capability
Strong population health programs can still fall short when the clinical, behavioral health, and community-based organizations surrounding them lack the shared workflows, communication structures, and alignment needed to work effectively together. Purva Rawal, PhD, and Leigh Wilson-Hall, MSW, Senior Advisors at the Camden Coalition, join Coral Director Ashley Fitch to discuss the Community Ecosystem Alignment Tool, or CEAT, and how it helps organizations turn cross-sector collaboration into a more intentional and operational capability. Their conversation explores why fragmented ecosystems can undermine otherwise promising interventions, how CEAT helps partners identify and reduce friction, what implementation looks like in practice, and how stronger alignment can support better execution across maternal health, behavioral health, transitions of care, and integrated or value-based models.