Health Care Matters | March 14, 2025
Health Policy Tracker: Trump’s First 100 Days
Medicare Payment Fix Delayed in Budget Talks
The continuing resolution passed by Congress Tuesday night did not include the "doc fix" for Medicare physician payment rates, which will instead be addressed in the upcoming budget reconciliation process. This decision delays the resolution of a 2.83% cut to Medicare physician payments that took effect on January 1. For more, read the following:
CMMI Announces Cancellation of 8 Models by the end of 2025
The Center for Medicare and Medicaid Innovation (CMMI) has announced the cancellation of eight payment models by the end of 2025. This decision is part of a broader strategy to streamline their focus on models that align with the goals of the Trump administration and HHS Secretary Robert F. Kennedy Jr.'s agenda. Models being canceled include those focused on primary care (Making Care Primary and Primary Care First), at-home dialysis, two models in the drug space, and two state-based models. Participants in the affected models will have until the end of 2025 to transition to other models. Read more here and here.
Why It Matters
Many of these cancellations aren't surprising, as several models were already slated to end in the near future or were pre-implementation with limited momentum. For instance, the $2 generic drug model lacked stakeholder enthusiasm, while the Accelerating Clinical Evidence Model had already been slow-rolled by CMS, making their discontinuation foreseeable. States like Maryland and Vermont are transitioning to the AHEAD model, and the Primary Care First (PCF) program had an established end date of 2026.
However, the cancellation of primary care models, particularly the Making Care Primary (MCP) model, presents significant challenges for participating providers.
MCP was launched as a 10-year test to bring new organizations, specifically community health centers and FQHCs, into VBP arrangements. Providers have already made investments in care delivery changes and will need to find new ways to sustain these investments or discontinue the investments which could impact patient care and access.
In addition to these challenges, there are critical details still to be clarified, such as when payments will stop for these models and what that means for quality reporting and measurement. Since quality performance in models like PCF directly influences future payments, how this will be managed moving forward remains a key concern for many providers.
Looking ahead, CMMI is developing a new strategy that aligns with the current administration’s goals. While we can expect announcements about new models soon, it's important to recognize that the runway for launching these initiatives may take some time, leaving providers with limited immediate options.
Policy Strategies To Propel Community Health Centers Into Value-Based Payment
An article published in Health Affairs, and co-authored by Coral’s ally Hope Glassberg of Decipher Health, underscores the importance of strategic investments to help community health centers (CHCs) transition to value-based payment (VBP) models. CHCs face unique challenges in adopting VBP due to the diverse populations they serve and the comprehensive services they offer, which often address social determinants of health and promote health equity. The authors point to several recommendations for policymakers to support CHCs in the move to VBP, including enhancing visibility into VBP participation and performance, providing dedicated funding, such as temporary infrastructure payments or grants, and standardizing VBP contracting terms to reduce administrative burdens. Read here.
Why It Matters
Community health centers (CHCs) are at a critical juncture, facing ongoing budgetary challenges and the looming threat of Medicaid cuts that could jeopardize their viability with Medicaid accounting over 40% of CHC budgets. If policymakers fail to act, the already tenuous financial stability of CHCs could unravel, leaving millions of the most vulnerable Americans without health care access they desperately need. The coming years will likely be marked by intense pressure on these centers as they work to stay afloat amid changing payment models and tightening budgets. But for now it remains a waiting game as the clock ticks toward the full implementation of Medicaid cuts.
What We Are Reading
Patients’ Trust in Health Systems to Use AI
A new study from the University of Minnesota, published in JAMA Network Open, finds that most people do not trust their healthcare providers to use AI technology responsibly. Read more here.
Price Transparency: A Regulatory Priority
As we shared in late February, the Trump administration continues to lay out its regulatory priorities including the executive order on price transparency. While the executive order mainly focuses on enforcing current price transparency requirements, it also hints at changing or even expanding them, which would require rulemaking to accomplish. Regs and Eggs published a blog to understand this executive order and potential changes to existing price transparency requirements. Read here.
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