Latest on the Affordable Care Act marketplaces: Will recent enrollment surge be short-lived?
In its final days, the Biden administration tried to cement gains made during the past few years in the uptake of insurance coverage provided through the Affordable Care Act (ACA) marketplaces. A final rule published Jan. 15 seeks to carry the recent momentum into 2026 via small steps and technical updates such as changes to…
Direct-to-employer benefit design: A providers’ starter guide
Following a decade of experience in developing value-based care bundle programs, Nashville, Tenn.-based Vanderbilt University Medical Center (VUMC) has enjoyed success in direct contracting with employers that demonstrates the ripe market opportunity such contracting offers. Health systems that want to seize this opportunity can benefit from applying VUMC’s lessons learned during this process to their…
Medicaid funding questions swirl after White House orders widespread spending pause (updated)
Jan. 29 update: The White House on Wednesday retracted the OMB memo implementing the general pause of federal grant and loan spending, saying a stringent review of agency spending nonetheless will continue and funding for agencies and programs could still be frozen if deemed to be used in a way that’s contrary to the administration’s…
Proposed MA rate notice for 2026 looks promising for health plans, which soon could reap more gains
The Biden administration’s final action with respect to Medicare Advantage (MA) provided a boost to health plans, which could fare better yet under the Trump administration. For 2026, MA plans would receive a 2.23% increase in their payment benchmarks, according to an advance rate notice posted Jan. 10. That would represent a reversal from 2024…
How ACOs should prepare for the 2025 requirements around quality reporting
This year, MSSP ACOs face increased pressure to enhance care quality and manage costs with the transition from manual to electronic clinical quality measures (eCQMs) and the MSSP’s intensified compliance requirements. This shift to electronic reporting is a financially driven transformation. The reporting complexity has increased significantly as ACOs are now required to report on…
GOP puts ideas for major healthcare spending cuts in writing
Big healthcare provisions and programs face the prospect of cutbacks as congressional Republicans look to pass a budget for the remainder of FY25. With Donald Trump in place for a second presidential term starting Monday afternoon and narrow Republican majorities in both chambers of Congress, the GOP has a chance to influence federal policy on…
UnitedHealth Group leaders reflect on slain colleague, how the industry can improve
In their first investor call since the targeted killing of their colleague spawned intense debate about aspects of the U.S. healthcare system, UnitedHealth Group leaders said a systemwide focus on improvement is needed. CEO Andrew Witty began this week’s Q4 earnings call by paying tribute to Brian Thompson, UnitedHealthcare’s chief executive, who was fatally shot…
Comparison of Final 2025 OPPS Addendum B with October 2024 Addendum B
HFMA presents a spreadsheet comparing relative weights and payment rates at the HCPCS level.
Comparison of Final 2025 OPPS Addendum A with October 2024 Addendum A
HFMA presents a spreadsheet comparing relative weights and payment rates at the APC level, using the most recent 2025 and 2024 Addendum A spreadsheets.
Medicare financial support for low-wage hospitals hits another roadblock in the courts
Plaintiff hospitals won a second consecutive appeals-court victory in the legal fight over Medicare’s low-wage-index policy. In December, the U.S. Court of Appeals for the Ninth Circuit upheld a district court’s ruling that the policy of increasing wage-index values for rural hospitals starting in 2020 was impermissible under the Medicare statute. The decision echoed a…