CY2025 Medicare Advantage Final Rule

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.