Resources

LEAD gives MSSP ACOs and health systems with deep value-based care experience a way to serve High Needs beneficiaries on payment terms that align with their acuity and changing care needs. Its benchmarks, risk adjustment, and monthly capitation features respond to structural challenges that established organizations have encountered in other models, aiming to generate lower utilization and total cost of care for High Needs beneficiaries while improving outcomes.

Community-based care models can help close the gap between what older adults can afford and the long-term care they need to stay in their homes. This joint AARP Public Policy Institute and ATI Advisory report offers a program replicability framework and three in-depth profiles, with practical lessons for state and local leaders working to sustain care options outside of Medicaid.

Nearly six years after Medicare Advantage opened up to people with end-stage renal disease, enrollment has climbed to nearly 280,000 beneficiaries, more than half of all Medicare beneficiaries with ESRD, and almost double what CMS originally projected. ATI Advisory's analysis of six years of Medicare data shows Medicare Advantage has become the primary way ESRD care gets paid for. Nephrologists, dialysis providers, and MA organizations are now negotiating payment rates, building provider networks, and navigating utilization management for a population that used to be financed almost entirely through fee-for-service.

Compliance deadlines tied to the Access Rule's HCBS provisions will start to arrive in 2027, with additional milestones in 2028 through 2030. In a recent webinar, ATI experts Bill Hanna and Cleo Kordomenos were joined by Camille Dobson, deputy executive director at ADvancing States, to discuss next steps for impacted healthcare stakeholders.

Beginning January 2028, CMS will launch a nationwide, mandatory bundled payments model for the first time. The Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, an expansion of the recently concluded Comprehensive Care for Joint Replacement (CJR) Model, will hold more than 2,000 acute care hospitals nationwide accountable for the cost and quality of inpatient and outpatient lower extremity joint replacement (LEJR) episodes. Episodes will span the initial LEJR procedure and all Medicare spending in the 90 days following the procedure, including post-acute care.

Aging services and senior living organizations are designed to keep frail older adults with complex, chronic needs healthier, more independent, and out of the hospital and emergency room. This work generates economic value by lowering the total cost of caring for the populations served. A robust value-based payment strategy turns that value into revenue the organization keeps.