CENTER UPDATE | September 2025

In this Issue:

  • CMMI’s New Strategic Direction: Three Priorities For Success
  • CMS chooses 6 states for WISeR Model
  • How Policymakers Across the Country Are Fighting the Health Care Affordability Crisis
  • Medical Debt Follows Cancer Patients Years After Diagnosis
  • Workers to bear brunt of health cost increases in 2026
  • Employers prepare for the highest health benefit cost increase in 15 years 
  • Type 2 Diabetes and Financial Outcomes
  • Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID
  • Fee-For-Service, Accountable Care Organizations, And Medicare Advantage: Why?
  • Choosing wisely & climate crisis: reducing lvc as a strategy to curb environmental impact

CMMI’s New Strategic Direction: Three Priorities For Success

The Center for Medicare and Medicaid Innovation (CMMI) released a new strategy emphasizing prevention, patient engagement, and empowering individuals to achieve their health goals. The strategy includes three goals: increasing patient engagement, leveraging data and technology, and protecting taxpayer interests. To achieve these goals, CMMI should prioritize behavioral science principles in model design, encourage technology adoption through reimbursement reform, and address inefficiencies across the Medicare program. Read more.

CMS chooses 6 states for WISeR Model

The CMS Innovation Center will test prior authorization for Medicare coverage of selected services in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Medicare administrative contractors in the states chosen for the Wasteful and Inappropriate Service Reduction demonstration project already have coverage policies for the targeted services and will refer to those policies when deciding whether to approve coverage. Read more.

States Stepping Up: How Policymakers Across the Country Are Fighting the Health Care Affordability Crisis

United States of Care recently released a report highlighting state legislative action on affordability in 2025. The analysis identifies 3 trends in addressing health care affordability: Lowering hospital prices and addressing consolidation, advancing consumer protections, and preserving access to coverage.

Medical Debt Follows Cancer Patients Years After Diagnosis

A recent JAMA Oncology study reports that modest amounts of medical debt linger in collections for up to six years after a cancer diagnosis, even in Massachusetts where insurance coverage is high. While average medical debt rose only by about $15 over that period, patients with colorectal or bladder cancer saw significantly larger increases. The findings underscore a persistent financial burden for cancer survivors and highlight the urgent policy need for stronger protections against long-term medical debt.

Workers to bear brunt of health cost increases in 2026

A recent Axios article reports that in 2026, large employers are expected to shift more health costs onto workers—raising premiums by as much as 10%, reflecting surging medical expenses and inflation. This marks a break from recent years when employers largely absorbed cost increases, signaling growing strain on employee coverage affordability. The trend underscores a pressing need for policy solutions that protect workers from escalating healthcare cost burdens and ensure equitable access to employer-sponsored insurance.

Employers prepare for the highest health benefit cost increase in 15 years

A recent Mercer article projects a 6.5% rise in employer health benefit costs for 2026—the steepest increase since 2010—driven by rising prices and utilization of services. “Health benefit cost trend has two primary components—healthcare price and utilization. Right now, both are rising,” says Mercer’s chief actuary, Sunit Patel. These pressures signal a growing challenge for cost containment and equity in employer-sponsored coverage, emphasizing the need for policy innovation to protect both budgets and workers.

Type 2 Diabetes and Financial Outcomes

Patients with type 2 diabetes are more likely than those without to experience financial hardships, according to a study in JAMA Network Open. Researchers studied EHR, credit and wage data and found that 64.5% of patients with diabetes had lower credit scores, higher debt and higher risks for bankruptcy and foreclosure than patients without diabetes. Adverse financial outcomes were most likely among Black, Hispanic, young or female diabetes patients and those covered by Medicaid.

Work Impairment and Financial Outcomes Among Adults With vs Without Long COVID

People with long Covid — those who have new or persistent symptoms lasting three months past infection — have experiencedworse financial and employment outcomes, lasting up to three years after their initial infection, compared with people who haven’t had the disease, according to a study published in JAMA Network Open.

Fee-For-Service, Accountable Care Organizations, And Medicare Advantage: Why?

This Health Affairs Perspective discusses the fiscal challenge facing Medicare and how that challenge may be differentially met by fee-for-service, accountable care organization (ACO), and Medicare Advantage (MA) payment systems. The non-MA part of Medicare includes both fee-for-service and ACO payment systems and is sometimes referred to as traditional Medicare. Fee-for-service, although in need of reform, is inherently ill suited to improving the efficiency of care delivery.

Choosing wisely and climate crisis: reducing low-value care as a strategy to curb healthcare environmental impact

This Internal and Emergency Medicine letter to the editor argues that the Choosing Wisely campaign’s efforts to reduce low-value medical care—like unnecessary imaging and antibiotic use—can also lower healthcare’s significant environmental footprint, including greenhouse gas emissions and pharmaceutical pollution. This approach aligns clinical effectiveness with ecological sustainability, offering a pathway where “doing less, when appropriate, is not just good medicine, it is also good planetary stewardship”.

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